with locations in Tolland and Ellington
860-559-1545
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FunCation Registration Form

Please fill out the form below.

ALL INFORMATION IS REQUIRED. FAILURE TO FILL OUT ALL FIELDS WILL RESULT IN HAVING TO START OVER.
School Your Child Will Be Attending: *   Ellington PSA   Tolland PSA   Early Beginnings
Child's Name: * Nickname:
Male Female
Child's Address: * Town: *
Zip:
Home Phone: * Date of Birth: *
Child Lives With: Both Parents Mother Father Other  
Billing Name (if different):  
Billing Address (if different):
Father's Name: * Occupation:
Business Address: Business Phone: *
Cell:
Mother's Name: * Occupation:
Business Address: Business Phone: *
Cell:
Email Address: *  
How did you hear about FunCation?
 


CHECK THE WEEKS YOU NEED:

1. June 29-July 2 (closed for the Fourth holiday on July 3)
2. July 6-10
3. July 13-17
4. July 20-24
5. July 27-31
6. August 3-7
7. August 10-14
8. August 17-21 (Early Beginnings Only)


DAYS AND HOURS REQUESTED: (Please indicate drop-off and pick-up times below)

Half Day: * 8:30am to 12:30pm (where available)
Full Day: * up to 6:45am - 5:45pm (less than 5 days a week)
Unlimited Week: *

Mon. * Tues. * Wed. * Thurs. * Fri. *

Names and birth dates of other children in the family

Name Date of Birth


Names and Phone Numbers of persons who may drop off or pick up your child at the preschool:
Note: These people will need to show identification before being allowed to take your child.

Name Phone
* *
* *
* *


Parent/Guardian Signature


Date

A $20.00 per child non-refundable registration fee is due with this form.
There is no registration fee for children registered for the 2013-14 or 2014-15 school years.

 

MEDICAL TREATMENT FORM

In the event you cannot be reached, please provide the names and phone numbers of persons who may be called in case of illness or emergency:

Name Phone
* *

 

Child's Physician: * Phone Number: *
Child's Dentist: * Phone Number:*

I give permission to have my child, , receive appropriate medical treatment and/or be taken to the hospital in case of an emergency.

Signature of Parent/Guardian *

Date *

 

WALKING PERMISSION FORM

I give my permission for my child, to go on walking field trips with his/her class. I understand that I will be given details before each trip as to where they are going, why and for how long. I will be informed of the trip at least one day in advance, and I do not need to sign before each one as this form will be acceptable. I understand that each trip will be no more than 1/2 mile from the school and that there will always be at least 2 adults with the children at all times. If I do not wish my child to go on the field trip, I need to contact the school well in advance, so other arrangements can be made.

If my child is enrolled in Kindergarten, the teacher may take my child on any walking trip near the school at any time the teacher sees fit. These trips need not be planned in advanced and the teacher will be in charge of the small class alone. Examples: lunch at the gazebo, walk at Arbor Park, library, hardware store, etc.


Signature of Parent/Guardian

Date

 

REQUEST FOR ADDITIONAL INFORMATION

The preschool staff strives to provide your child with the highest quality care and this can best be accomplished by becoming more sensitive to your child's particular needs. Please review and complete the questions below which are applicable to your child and return this form with your school application forms. Thank you, and we look forward to seeing you and your family at the Preschool of the Arts:

 

Does your child:  
- have any known allergies? Yes No
- is there any food that should be restricted from their diet? Yes No If so, what?
- have any bathroom routines we should be aware of? Yes No If so, please explain:
- have any medical concerns we should be aware of? Yes No If so, please explain:
Is there anything else we should know?
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