Rabbit Creek Preschool Registration Form
ENROLLMENT REQUIREMENTS:
1. Bunnies (3's) must be 3-years old by September 1, 2010. Rabbits (4's) must be 4 by September 1, 2010.
2. The child must be toilet trained and self sufficient in the bathroom. A reasonable effort will be made to accommodate children with special needs.
3. The child must have a certificate of good health (within 1 year)

Name of Child: _______________________________

Nickname: _______________________________

Child's Birthdate: _____________________________

Age as of September 1st: ____________________

Father's Name: _________________ Occupation: _________________

Mother's Name: ________________ Occupation: __________________

Mailing Address: ____________________________ Zip Code: _______

Street Address: ______________________________

Home Phone: ________________________________

Work Phone: _________________________________

Cell Phone(s):________________________________

E-Mail: __________________________________

Does your child have any previous preschool/day care experience?: _____

How did you hear about our program?: ________________________________

TO ENROLL MY CHILD, I AGREE TO THE FOLLOWING:
1) Payment of $75.00 non-refundable registration fee.
2) Payment of May 2011 tuition of: (check box)
    □ Bunnies (3's) $120.00 at the time of registration, refundable up until August 15, 2010.
    □ Rabbits (4's) $160.00 at the time of registration, refundable up until August 15, 2010.  AM class or PM class (circle one)
3) Payment of monthly tuition of: (check box)
    □ Bunnies (3's) $120.00 to be paid on the 1st of each month and no later than the 10th of each month. If delinquent, I agree to pay a late fee of $5.00.
    □ Rabbits (4's) $160.00 to be paid on the 1st of each month and no later than the 10th of each month. If delinquent, I agree to pay a late fee of $5.00. Circle one: AM CLASS or PM CLASS
4) I understand that parent involvement is an important part of this program and that I am expected to spend one class time every 4 - 6 weeks assisting the teachers in the preschool class. This is a mandatory requirement.
5) I will provide a nut-free nutritious snack, cups, napkins, etc. on the helping day.
6) I will attend the mandatory spring (Tuesday, April 13th, 2010) and fall (Friday, August 20th) parent meetings.
7) I will read and be familiar with the Preschool Guidelines and Parent Responsibilities.
8) I will provide a current shot record and a completed doctor's health form for my child prior to the first day of class.

RCP does not discriminate in admission on the basis of gender, marital status, pregnancy, parenthood, race, religion, color, national origin, age, or physical handicap.
I, named above, as a participant or as parent or legal guardian of a participant in classes sponsored by the Rabbit Creek Community Association Preschool Program, 2009/2010 school year, recognize that some of the classes involve physical activities that have risks and injuries associated with participating in these classes including, but not limited to those of bodily injury, partial or total disability, paralysis, and death. Knowing that there is a risk of bodily injury, partial or total disability, paralysis, and death or personal property damage, I, named above, for myself, my heirs, administrators, executors and assignees, hereby waive, release, discharge, covenant and agree that I will never institute any demand, claim, or suit against the Rabbit Creek Preschool and Rabbit Creek Community Association Preschool Program, and or their employees, agents, and volunteers for any bodily injury, partial or total disability, paralysis, and death or personal property damage that might occur from any cause whatsoever as a result of my participation in the activities of the Rabbit Creek Community Association Preschool Program. I accept full responsibility for the cost of treatment for any injury suffered while taking part in the Rabbit Creek Community Association Preschool Program.

Signature: __________________________________ Date: _______ Phone: ___________

Emergency Name: _______________________________ Phone: ____________________