Arborlawn Children’s Academy
2016-2017 Registration Form
Child’s Name _________________________________ Date of Birth ____________ Boy/Girl
Address ______________________________________ City _________________ ZIP ________
Home Phone ____________________________
Mother’s Name ______________________________________ Cell Phone _______________
Address if different from above __________________________________________________
Place of Employment _______________________________ Work Phone _______________
Email ______________________________________________
Father’s Name ______________________________________ Cell Phone _______________
Address if different from above __________________________________________________
Place of Employment _______________________________ Work Phone _______________
Email ________________________________________________
Class Options
(Class is determined by age on 9/1/2016)
9:00 am – 2:00 pm
2 day M/W or T/TH $224.00 monthly (ages 8 weeks – 2 years old)
3 day MWF $336.00 monthly (ages 8 weeks – 4 years old)
5 Day M-F $550.00 monthly (ages 8 weeks – 4 years old)
Extended Day available from 2:00 pm – 4:00 pm
$12.00 Daily w/advanced registration $15.00 Daily w/o advanced registration
$75.00 Registration Fee due with registration form (non refundable)
Supply Fee equal to one month’s tuition due by June 15, 2016
Infant Class (8 weeks – 11 months): M ____ T ____ W____ Th____ F____Extended Day ______
Toddler Class (12 months – 23 months) M ___ T ___ W ___ Th ___ F ___ Extended Day ____
2 year old Class M ___ T ___ W ____ Th ____ F ____ Extended Day _______
3 year old Class M ___ T ___ W ____ Th ____ F ____ Extended Day _______
4 year old Class M ___ T ___ W ____ Th ____ F ____ Extended Day _______
Permission to photograph child: Throughout the year we will be taking photos of
the children to display in the rooms, hallways, newsletters or social media sites to
promote our program. We will never use the names of specific children on social
media.
I give permission for my child’s photo to be used ___________
I do not give permission for my child’s photo to be used __________
I give permission for my child to participate in water play activities ________
I do not give permission for my child to participate in water play activities _______
(Water play activities include water tables, sprinklers but does not include
swimming pools)
Known Allergies: ____________________________________________________________
Names and Ages of Siblings
_________________________ ______
_________________________ ______
_________________________ ______
__________________________ ______
__________________________ ______
__________________________ ______
Names of Adults (other than child’s parents) who have permission to pick up your
child. This information can be updated as needed throughout the year.
Name ___________________________ Relationship to Child ________________________
Phone Number ________________________________________
Name ___________________________ Relationship to Child ________________________
Phone Number ________________________________________
______________________________________________________________________________
Parent or Legal Guardian Signature
Date
Office Use Only
Registration Fee Paid ______________
Enrollment Packet Complete _________
Date of Enrollment ___________