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PRESCHOOL ENROLLMENT 2019-2020

Enrollment for the 2019-2020 preschool year is in progress. Please return your enrollment form and registration fee as soon as possible, as registration is on a first-come first-served basis. This will hold your student’s seat for the upcoming school year. Individuals that have turned in an enrollment form and/or registration fee after the class is full will be placed on a waiting list and the registration fee returned.

The $40 registration fee must be included with these forms to hold your child’s spot.

Tiny Footsteps Preschool will closely follow the Davis School District calendar. A calendar of the school year will be provided for you once it is available and/or you are enrolled.

Please return your forms and fee to the address below or call to drop them off in person:

Jennifer Munk

1062 Arlington Way

Bountiful, UT 84010

Please be aware that your first payment (either $75 or $120) is due on or before the first day of class or your child may not attend class. Please make checks payable to Jennifer Munk.

If you have any questions, please feel free to call Jennifer Munk (801-598-8719).

We look forward to hearing from you and the opportunity to get to know you and your child better over the coming months.

Sincerely,

Megan Bowden, Jennifer Munk, and MaryKate Traeden

APPLICATION FOR ENROLLMENT

Student's Full Name ____________________________________________________

Birth Date _______________________________

Mother __________________________________ Occupation ___________________

Phones: Home ____________ Work _________________ Cell ____________________

Father ___________________________________ Occupation ___________________

Phones: Home ____________ Work _________________ Cell ____________________

Parents: Married ______ Cohabiting ______ Divorced ______ Separated _______

Home Address _________________________________________________________

City _________________________ Zip Code _________________

E-mail Address(es) ______________________________________________________

Mailing Address ________________________________________________________

Others Authorized To Pickup (Name/Phone Number/Relationship):____________________ _____________________________________________________________________

Others to Contact In Case Of Emergency (Name/Phone Number/Relationship): __________

_____________________________________________________________________

Medical Conditions/Allergies/Serious Illnesses or Accidents/Complications during pregnancy or birth: ______________________________________________________________ __________________________________________________________________________________________________________________________________________

Family predispositions (ADHD / Dyslexia / Learning Disabilities): ____________________

_____________________________________________________________________

Discipline methods used at home: ____________________________________________

Siblings (name/birth year): ________________________________________________

_____________________________________________________________________

Schools previously attended: _______________________________________________

Describe your child: _____________________________________________________

Goals for your child: _____________________________________________________

How did you learn about Tiny Footsteps Preschool? _______________________________

Signature _______________________________________ Date __________________

ENROLLMENT AGREEMENT

I, _____________________________ (your name), am the parent or legal guardian of ____________________________ (child's name), whose birth date is ____________.

I would like to enroll my child at Tiny Footsteps Preschool for the _______________ school year or remainder thereof. I am financially responsible for this child and agree to all of the terms and conditions contained on both pages of this Enrollment Agreement.

I have enclosed the non-refundable Registration Fee ($40.00) and request the following program (understanding that children must be 3 by Aug 31st for preschool A or 4 by Aug 31st for preschool B):

Morning:

_________ Preschool A (ages 3-4), 9:30am – 11:45 am, T/Th ($75/month)

_________ Preschool B (ages 4-5), 9am – 12:00 pm, MWF ($120/month)

I understand and agree that the Registration Fee is non-refundable if I am placed on the class list.

Special considerations __________________________________________________

___________________________________________________________________

I understand and agree with the terms of this Enrollment Agreement.

Signature __________________________________________ Date _____________

(Parent or legal guardian who is financially responsible for the child)

Signature __________________________________________ Date _____________

(Administrator of Tiny Footsteps Preschool)

PAYMENT AGREEMENT

I hereby choose and agree to the following payment option for tuition due.

________ Option 1: I will pay the tuition due per month directly to Jennifer Munk. I understand that tuition is due on the 1st day of the month and agree to pay a late payment of $20.00 for any late tuition payments and a $40.00 fee for any bounced checks.

________ Option 2: I will pay the tuition due in full directly to Jennifer Munk. Preschool A tuition is $675.00 for the year and Preschool B tuition is $1080.00 for the year.

Please make checks payable to Jennifer Munk.

I understand that my first payment is due on or before the first day of class or my child may not attend.

I understand and agree that I am enrolling my child for the entire school year or remainder thereof. If it becomes necessary for my child to withdraw early, I agree to notify the school verbally or in writing, one month prior to withdrawal. I understand and agree that if I am making monthly payments, my account must be current as of the withdrawal date and payments already made are non-refundable. I understand and agree that if I am paying tuition in advance that those advance tuition payments are mostly refundable.

I understand and agree that if it is determined at any time, in the sole judgment of the Administrator of Tiny Footsteps, that the interests of the student or the school would be best served if the student was not enrolled at Tiny Footsteps Preschool, then the student will be dismissed. I understand and agree that if my student is dismissed, my account must be current and payments already made are refundable past the last day of the last class attended. I understand and agree that I am paying tuition in advance and that those advance tuition payments are non-refundable. I agree to pay to Tiny Footsteps Preschool any costs or expenses, including legal fees, relating to or arising out of the collection by Tiny Footsteps Preschool of any tuition due pursuant to this Enrollment Agreement. I further agree to pay 5% monthly interest on any past due balance pursuant to this Enrollment Agreement.

The laws of the State of Utah govern this Enrollment Agreement. I understand and agree with the terms of this Payment Agreement.

Signature __________________________________________ Date _____________

(Parent or legal guardian who is financially responsible for the child)

Signature __________________________________________ Date _____________

(Administrator of Tiny Footsteps Preschool)

EMERGENCY MEDICAL AUTHORIZATION

AND RELEASE AGREEMENT

I, ______________________________ (name), am the parent or legal guardian of __________________________ (child’s name). I understand and acknowledge that my child may require first aid and/or emergency medical care for illness or accidental injury occurring at Tiny Footsteps Preschool. (Tiny Footsteps Preschool shall hereinafter refer to Tiny Footsteps Preschool, its agents, directors and employees). In the event that my child should become or appear to become injured or ill, I hereby authorize Tiny Footsteps Preschool to render such first aid to my child as may appear reasonably necessary under the circumstances. Tiny Footsteps Preschool may take such actions as appear reasonable, necessary or in the best interests of my child and other children. Tiny Footsteps Preschool may transport my child to the family doctor named herein or to any other hospital or emergency center which Tiny Footsteps Preschool may, in its sole discretion, determine necessary or appropriate under the circumstances.

I further confer upon Tiny Footsteps Preschool all requisite authority to act in my place and stead in authorizing such emergency medical care or treatment as may be found necessary or advisable by any health care professional. In the event my child should experience a medical emergency requiring professional health care services Tiny Footsteps Preschool will use reasonable efforts to notify me as soon as possible but will not delay authorization of any medically necessary treatment.

In the event that Tiny Footsteps Preschool is required to execute an acceptance of financial responsibility to promptly obtain medical care for my child, I hereby unconditionally guarantee prompt and full payment for all medical services rendered. I further agree to reimburse, indemnify and hold harmless Tiny Footsteps Preschool for all medical costs and expenses incurred on behalf of my child and all other sums of any kind related to such medical costs or expenses.

I hereby WAIVE, RELEASE AND DISCHARGE ANY AND ALL CLAIMS against Tiny Footsteps Preschool for damages for death or personal injury my child may suffer as a result of (1) any efforts by Tiny Footsteps Preschool to render First Aid; (2) emergency transportation to or from any doctor, hospital or emergency center by Tiny Footsteps Preschool, (3) handling, diagnosis, treatment or care of my child by any doctor, hospital, emergency center, or emergency transport provider; and (4) failure to render or seek first aid or medical care for my child.

Each waiver and release contained herein, I make on behalf of myself, my child and any other parent or guardian of my child. By these waivers and releases, I intend to give up my right, my child’s right and the right of any other parent or guardian of my child to assert or maintain any claim or suit against Tiny Footsteps Preschool for the activities or occurrences described herein. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THE WAIVERS AND RELEASES CONTAINED HEREIN and I agree to indemnify and hold harmless Tiny Footsteps Preschool for any liability of any kind arising out of any lack of authority on my part to make such waivers and releases.

I have read, understand and agree with the terms and conditions above.

Signature_____________________________________________________ Date _______________

Medical or Health Insurance policy carrier: _______________________________________________

Policy Number: ____________________________________________________________________

Child’s Doctor: _________________________________________________ Phone: ______________

Doctor’s Address: __________________________________________________________________

AUTHORIZATION TO ADMINISTER MEDICATION

AND RELEASE AGREEMENT

I, ___________________ (name), am the parent or legal guardian of ______________________

(child’s name). I authorize and direct Tiny Footsteps Preschool (Tiny Footsteps Preschool shall hereinafter refer to its agents, directors and employees) to administer medication to my child as described below.

Tiny Footsteps Preschool will administer prescription medication only from the container from which it was dispensed by my registered pharmacist and only in accordance with the instructions printed on the container by my registered pharmacist. Tiny Footsteps Preschool will not administer prescription medication to my child from a container that indicates that the prescription has expired, or that the prescription was not issued for my child. I hereby WAIVE, RELEASE AND DISCHARGE ANY AND ALL CLAIMS against Tiny Footsteps Preschool for damages for death, personal injury or property damage my child or I may suffer as a result of Tiny Footsteps Preschool’s administration of prescription medication in accordance with its printed instructions.

Tiny Footsteps Preschool will administer non-prescription medication according to my written instructions. I ACCEPT FULL RESPONSIBILITY FOR THE CONSEQUENCES OF ADMINISTRATION OF NON-PRESCRIPTION MEDICATION ACCORDING TO MY INSTRUCTIONS. Tiny Footsteps Preschool shall have no duty or obligation to check the reasonableness or propriety of my instructions and I WAIVE, RELEASE AND DISCHARGE ANY AND ALL CLAIMS against Tiny Footsteps Preschool for damages for death, personal injury or property damage I or my child may suffer as a result of Tiny Footsteps Preschool’s administration of non-prescription medication in accordance with my instructions.

Each waiver and release contained herein, I make on behalf of myself, my child and any other parent or guardian of my child. By these waivers and releases, I intend to give up my right, the right of any other parent or guardian of my child and my child’s right to assert or maintain any claim or suit against Tiny Footsteps Preschool for the activities or occurrences described. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THE WAIVERS AND RELEASES CONTAINED HEREIN and I agree to indemnify and hold harmless Tiny Footsteps Preschool for any liability of any kind arising out of any lack of authority on my part to make such waivers and releases.

I have read, understand and agree with the terms and conditions above.

Signature ________________________________________________ Date ______________

FIELD TRIP AUTHORIZATION

AND RELEASE AGREEMENT

I, _____________________ (name), am the parent or legal guardian of _________________ (child’s name). I authorize and direct Tiny Footsteps Preschool (Tiny Footsteps Preschool shall hereinafter refer to its agents, directors and employees) to transport my child on field trips. I also hereby grant permission for parent volunteers to transport my child on field trips and for my child to participate in field trips.

Students enrolled in Tiny Footsteps Preschool routinely take field trips. During these field trips, students may be required to walk or be transported in Tiny Footsteps Preschool or parent volunteer vehicles. Tiny Footsteps Preschool strives to offer a safe and educational experience for your child. Tiny Footsteps Preschool will not be liable for any incidents or accidents occurring during a field trip. Tiny Footsteps Preschool will make all reasonable efforts to notify you of any incident or accident occurring during transportation or participation in a field trip.

I hereby WAIVE, RELEASE AND DISCHARGE ANY AND ALL CLAIMS against Tiny Footsteps Preschool for damages for death, personal injury or property damage my child or I may suffer as a result of being transported by a parent volunteer or Tiny Footsteps Preschool or participation in a field trip.

Each waiver and release contained herein, I make on behalf of myself, my child and any other parent or guardian of my child. By these waivers and releases, I intend to give up my right, my child’s right and the right of any other parent or guardian of my child to assert or maintain any claim or suit against Tiny Footsteps Preschool for the activities or occurrences described. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THE WAIVERS AND RELEASES CONTAINED HEREIN and I agree to indemnify and hold harmless Tiny Footsteps Preschool for any liability of any kind arising out of any lack of authority on my part to make such waivers and releases.

I have read, understand and agree with the terms and conditions above.

Signature__________________________________________ Date ____________________

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