Sky Valley Preschool Academy Summer Registration 2009 Parent Authorization for Participation & Medical Release   Students Name:________________________________________________________________________________________________________ Address:______________________________________________________________________________________________________________ City:__________________________________________________________________State:______________Zip:_________________________ Phone:_________________________________________________________________Cell:___________________________________________ Mothers Names:_______________________________________________________________Phone:___________________________________ E-Mail______________________________________________________________________Cell:_____________________________________ Fathers Name:________________________________________________________________ Phone:___________________________________ E-Mail______________________________________________________________________Cell:_____________________________________ Emergency Contact: ____________________________________________________________Phone:___________________________________ Students Birth Date: _____________________________________________________________Age:____________________________________ Authorization for pick up:________________________________________________________________________________________________ Allergies:______________________________________________________________________________________________________________ Doctors Name:____________________________________________________________________Phone________________________________ Medications:___________________________________________________________________________________________________________ Summer Registration  $50.00 Tuition & Classes ( Circle One) ( All field trips are included in fees) 3 - 5 year olds Mornings Tues & Thurs  9:00 - 12:00   $150.00 per month - $300.00   7 Week Summer Session 3 - 5 year olds Mornings  Tues, Wed & Thurs 9:00 - 12:00   $180.00  per month - $360:00  7 Weeks Summer Session I understand this form legally releases all obligations and responsibilities to Sky Valley Preschool/ Gymnastics Academy/Staff / Teachers for the medical treatment of my daughter/son in the event of illness or injury during school and/or school related activity when either parent cannot be reached. If there is any physical or medical reason why he/she should not participate fully at an Sky Valley Preschool Academy event requires a doctor’s release. I also release Sky Valley Preschool Academy / Gymnastics Academy of any and all responsibility due to accident or injury during any type of activity during the school year. I acknowledge that my daughter/son is enrolled in Sky Valley Preschool Academy and will participate in all school activities. I understand that each child must abide by the rules and regulations set forth by the teachers at Sky Valley Preschool Academy. I have read the rules and regulations and understand them completely. I understand that a violation of any of these rules my lead to temporary or permanent suspension from the school. I give Sky Valley Preschool Academy permission to post or use photos throughout the year on flyers or bulletin boards. Yes__________No_________ Parent /Legal Guardian Signature:_____________________________________________________________Date______________________