THRIVE PRESCHOOL REGISTRATION 2024

LEGAL NAME

NICKNAME

BIRTHDATE

CLASS CHOICE

TUESDAY/THURSDAY (3 by August 31st 2024)

GENDER

Male Female

1st PARENT /GUARDIAN'S INFORMATION

1st PARENT OR GUARDIAN NAME

RELATIONSHIP

MOTHER FATHER Other

LIVES WITH CHILD

YES NO

YOUR BEST EMAIL

This address will receive a confirmation email

BEST PHONE NUMBER

HOME ADDRESS

EMPLOYER

WORK PHONE

2nd PARENT OR GUARDIAN

PARENT OR GUARDIAN NAME

RELATIONSHIP MOTHER FATHER OTHER

LIVES WITH CHILD YES NO

YOUR BEST EMAIL

BEST PHONE NUMBER

AUTHORIZED TO PICK UP YES NO

EMPLOYER

WORK NUMBER

EMERGENCY CONTACTS

NAME

PHONE

RELATIONSHIP

AUTHORIZED TO PICK UP

YES NO

NAME

PHONE

RELATIONSHIP

AUTHORIZED TO PICK UP

YES NO

MEDICAL RELEASE

In case of emergency, we the parents or legal guardians of above named child give the staff of Thrive Preschool (Thrive Church) permission to obtain medical attention as needed for the immediate welfare of our child. We also agree, under the fornamed circumstances to pay for all medical expenses involved.

RELEASE

YES, I agree to the above statement of medical release NO, I do not agree to the above medical release

MEDICAL INFORMATION

ALLERGIES (medication, food, environmental, etc.)

MEDICATIONS and REASON:

(Thrive Preschool does not have a nurse on staff. Medications needed during school hours must be administered by parent or authorized adult.)

COMMUNICABLE DISEASE

MARK ALL THAT APPLY FOR ANY APPLICABLE POSITIVE RESPONSES CHICKEN POX MEASLES MUMPS HEPATITIS WHOPPING COUGH OTHER

Please list Dates of any applicable positive responses

PLEASE SHARE ANY SPECIAL NEEDS OR ADDITIONAL MEDICAL INFORMATION (i.e. serious illness, accidents, recent operations or anything else that might be helpful for our staff to know)

CHILD'S PERSONALITY

SLEEP: What is your child's normal bed time? What time do they wake up?

SPEECH: Does your child speak plainly so that others, besides those at home, can understand? YES or NO? If No, please share below.

OTHER LANGUAGES: are there any languages, besides English, spoken at home? If so, which ones?

BEHAVIORS

Does your child have any significant fears? If so, please explain:

Are you aware of any significant social/emotional struggles? (anger, aggression, anxiety, hostility) If so, please elaborate:

Has your child experienced a significant trauma? (Loss, injury, family changes) If so, please share:

CORRECTION: What type of correction does your child receive at home? (ex. time out, removal of privileges, verbal correction, other) Please explain

DIETARY: Does your family practice any dietary restrictions for any reason? (gluten free, egg free, vegetarian, vegan)

MISCELLANEOUS: Is there anything else you would like us to know about your child that will help them while they are with us?

YOUR HOPES: What are you hoping to have your child gain from their time in class at Thrive Preschool?

PHOTOGRAPH AND VIDEO RELEASE

From time to time Thrive Preschool teachers will be taking photos of students during their activities within the premesis. With this in mind we would like your consent for publishing or print use of photos your child may be included in.

The photos will be used for bulltin boards, marketing or advertising and/or marketing updates posted via facebook page, website and or within the walls of the preschool and Thrive Church premesis.

Should you decide to take back your authorization at a later date, you may do so in writing.

For protection and privacy of your child we guarantee that your childs name will not be included.

AUTHORIZATION

I authorize Thrive Preschool to make use of photos involving my child I do not authorize use of photos taken involving my child

FAMILY INFORMATION

Please list all members of your childs immediate family.

NAME

RELATIONSHIP TO CHILD:

GENDER MALE FEMALE

LIVES WITH CHILD YES NO

NAME

RELATIONSHIP TO CHILD:

GENDER MALE FEMALE

LIVES WITH CHILD: YES NO

NAME

RELATIONSHIP

GENDER MALE FEMALE

LIVES WITH CHILD YES NO

NAME

RELATIONSHIP

GENDER MALE FEMALE

LIVES WITH CHILD YES NO

IF THERE ARE MORE FAMILY MEMBERS LIVING IN THE HOME PLEASE LIST THEM HERE

Do you have any other children that might attend Thrive Preschool? YES NO

THRIVE PRESCHOOL REGISTRATION 2024

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