Preschooler Information and Consent Forms Child Information * First Name Last Name What Child prefers to be called Childs Date of Birth Parent or Guardian Information First Name Last Name Address Phone (###) ### #### Emergency Contact Information (other than main contact) First Name Last Name Phone (###) ### #### Medical Conditions/ Allergies/ Medications Photo Permission Option 1 Option 2 Option 3 PAYMENT AGREEMENT * I understand that payments are to be made the first week of each month unless I have made other arrangements with Miss Kara. I also understand that if I am late picking my preschooler up without communicating with Miss Kara she has the right to apply a $5.00 fee for every 30 minutes late to next months tuition. Should I fail to pay my monthly tuition and or any late fees, I understand that Miss Kara has the right to refuse preschool services to my child. Emergency Medical Treatment * I authorize Kara Purcell, to treat my child should anything emergent happen under her care. IF Kara Purcell feels emergent care is needed before my arrival, she is authorized to call 911 for Ambulatory services. Thank you!
