Registration Form

Rabbit Creek Preschool
Mailing address: 13650 Lake Otis Parkway Anchorage, AK 99516 Physical address: 1612 Oceanview Drive Anchorage, AK 99515 Phone: 907-441-7574

Website: www.rabbitcreekpreschool.com

Email: rabbitcreekpreschool@yahoo.com

1. Bunnies (3's) must be 3-years old by September 1, 2012. Rabbits (4's) must be 4 by September 1, 2012.
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. I will provide a current shot record and a completed doctor's health form for my child prior to the first day of class.
4. Payment of $75.00 non-refundable registration fee.
5. Payment of May 2013 tuition of: (check box to choose class) □ Bunnies (3's) $120.00 at the time of registration, refundable up until August 15, 2012.
□ Rabbits AM & PM (4's) $160.00 at the time of registration, refundable up until August 15, 2012.
6. 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 $25.00 for the first and second occurrence. I will read and be familiar with the tuition policy regarding 3 late payments.
□ Rabbits AM & PM (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 $25.00 for the first and second occurrence. I will read and be familiar with the tuition policy regarding 3 late payments.
7. I understand that parent involvement is a vital 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 as well as donate my time to assist with a minimum of one school party or fundraising event during the school year. This is a mandatory requirement.
8. I will provide a nut-free nutritious snack, cups, napkins, etc. on the helping day.
9. I will attend the mandatory spring (Tuesday, April 10th, 2012) and fall (Friday, August 24^th, 2012) parent meetings 10. I will read and be familiar with the Preschool Guidelines and Parent Responsibilities.

Please keep this page for your records.

Rabbit Creek Preschool Registration Form

Name of Child: _______________________________

Nickname: __________________________________

Child's Birth date: _____________________________

Age as of September 1st: ____________________

What class are you enrolling in? Rabbits (4's) AM class, Rabbits (4's) PM class, or Bunnies (3's) class (Please list class choice here) _________________________________________

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? ________________________________

I have read and agree to abide by the enrollment requirements. _______________________________________________________

Parent/Guardian Signature Date:

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, 2012/2013 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 Preschool Program. I accept full responsibility for the cost of treatment for any injury suffered while taking part in the Rabbit Creek Preschool Program.

Signature: __________________________________ Date: _______ Phone: ___________

Emergency Name: _______________________________ Phone: ____________________