Joyful Noise Preschool
Joyful Noise Preschool Partners Inc. P.O. Box 1927
2020/2021 Sandy, Or 97055
503-668-7827
Student’s Name_____________________________Birthdate_________________
Other Name student goes by________________________(example: Jacob/Jake)
Gender: Male / Female
1ST YR STUDENTS
____MON/WED AM 9:00AM-11:30AM 1ST YR
____TUES/THURS AM 9:00AM-11:30AM 1ST YR
2ND YR STUDENTS
____MON/WED AM 9:00AM-12:00PM 2ND YR
____TUES/THURS AM 9:00AM-12:00PM 2ND YR
FRIDAY OPTIONAL DAY FOR ALL CLASSES
**(monthly themes along with reinforcement of letters and numbers)**
____OPTIONAL FRIDAY CLASS AM 9:00AM-11:30AM
CONTACT INFORMATION
Parent’s Name(s)___________________Custodial parent (if divorced)____________________
Address__________________________________City_________State_____Zip____________
Mailing address if different from above:
_________________________________________City_________State_____Zip___________
E-mail address:________________________________________________________________
Home phone______________Cell_________________Work___________________________
Church attending___________________Affiliation___________________________________
How did you hear about Joyful Noise? _____________________________________________
EMERGENCY CONTACT (other than parent): Name__________________________________
Home phone___________________Cell phone_________________
Relationship to student____________________________________
***Office use only—Date_______Book fee paid________Reg. fee________Supply fee_______
Tuition paid in advance____________ Date________________
Joyful Noise Preschool Partners Inc.
Financial Agreement Form 2020/2021
Tuition: (Tuition can be paid in full or for your convenience, 9 monthly equal payments can be paid beginning Sept 1-May 1.)
Preschool classes 1st yr---------------------------------------------$1,035/yr or…….$115/mo (2 day)
Preschool classes 1st year with Friday----------------------------$1,395/yr or ……$155/mo (3 day)
Preschool classes 2nd yr---------------------------------------------$1,170/yr or-------$130/mo (2 day)
Preschool classes 2nd year with Friday----------------------------$1,530/yr or-------$170/mo (3 day)
Military Parent family discount: 10% off tuition
Sibling Discounts: 10 % off the lesser tuition each month.
Fees: (per child)
1. Supply Fee (NON REFUNDABLE)----------------------$40.00 Preschool
2. Registration Fee (NON REFUNDABLE)----------------$50.00 Preschool
3. Book Fee (NON REFUNDABLE)------------------------$50.00 1st yr/ $60.00 2nd yr
ALL FEES ARE REQUIRED TO HOLD A STUDENTS SPOT AND ARE NON-REFUNDABLE.
Snack Policy: Each family is asked to bring in snack for the class at the beginning of the month or add an additional $5.00 to tuition each month.
Terms of Payments:_____INITIAL HERE
Payment schedule:
a. Payments are due on the 1st of each month (Sept.-May)
b. Any dishonored check by a bank or other institution for any reason including insufficient funds or closed account will result in a returned check fee of $30.00
c. There is no prorating of tuition for any reason including sick days, snow days, holidays, breaks, vacations.)
d. May tuition must be paid by the 10th to participate in graduation.
Delinquent tuition:
a. Tuition paid after the 10th of the month will incur a late fee of $25.00
b. Tuition that is not paid by the 20th of the month will result in dismissal if other arrangements have not been made.
c. Students are not allowed to return until all tuition and late fees are paid.
Late Pickup Charges:
a. Students picked up more than 5 minutes late will be charged $5.00 for every 5 minutes. Payment is due upon pickup of child.
Withdrawal of student:
a. To withdraw your child from school we require a 30 day notice. Tuition is to be paid until that date. Books remain property of the school and will not be given out.
I/WE UNDERSTAND AND AGREE TO FOLLOW THE OUTLINED PROCEDURES FOR PAYMENT
PARENT SIGNATURE__________________________DATE_____________
HEALTH HISTORY FORM
JOYFUL NOISE PRESCHOOL
Student’s Name (print)________________________Birthdate_____________
Insurance Company__________________Policy/Id Number______________
Health History:
Please (x) any of the following conditions your child has experienced and circle Yes/No
___Hearing Problems When?_________Tubes?________
___Vision Problems? Wears glasses? Yes/ No Contacts? Yes/No
___Allergies-List________________________________________________
______________________________________________________________
What happens?_____________________________________________
___Is Epi-Pen prescribed for allergies? Yes/ No (If yes, parent must provide)
___Bee sting allergy? What happened?______________________________
___Asthma-Is an inhaler used? Yes/ No How often?___________________
___List of medications taken for asthma_____________________________
___Diabetes?______________Medication for diabetes?_________________
___Seizures?__________What type?______________Last seizure_________
Medication taken for seizures__________________________________
___Hospitalizations – For what?____________________________________
___Episode of loss of consciousness? _________________When?_________
___Bone/Joint problem or fracture?_________________________________
Any recurrent medical problem or illness of which you want us to be aware of?__________________________________________________________________________________________________________________________________
List any activity restrictions:_______________________________________
List all prescription and over the counter meds your child takes regularly___________________________________________________________
_____MY CHILD IS HEALTHY AND HAS NO MEDICAL CONCERNS.
PERMISSION FOR MEDICAL TREATMENT
In the event the parents/legal guardians on this form cannot be reached, I hereby authorize staff of Joyful Noise Preschool Partners Inc. to consent on my behalf for emergency medical care for my child. I agree to assume financial responsibility for all expenses associated with the emergency care and or transportation for my child. I agree not to hold Joyful Noise Preschool Partners Inc. or its employees liable for any injury or losses related to the emergency care my child receives.
Physicians Name______________________Phone___________________
Location of office______________________________________________
Mother name_________________________ Phone___________________
Signature____________________________Date_____________________
Work address_________________________Work phone______________
Father name__________________________Phone___________________
Signature____________________________Date_____________________
Work address_________________________Work phone______________
Legal guardian_________________________Date___________________
Signature____________________________Phone___________________
Work address________________________Work phone_______________
**If your child is in the custody of one parent please indicate.
Joyful Noise Preschool Partners Inc.
CONSENT FOR RELEASE OF STUDENT PHOTOGRAPHS:
Throughout the school year, we may take photographs of your child during class for our Facebook/website purposes. If you give Joyful Noise Preschool permission to photograph your child for this purpose, please check the appropriate line and sign below. If you do not want your child photographed, please indicate by checking the appropriate line and sign below. Joyful Noise Preschool will not use your child’s photographs for any other purposes.
______I DO give permission to Joyful Noise Preschool to release photos for school Facebook/website.
______I DO NOT give permission to Joyful Noise Preschool to release photos for school Facebook/website.
Parent Signature____________________________Date_____________
Student Name______________________________________________
JOYFUL NOISE PRESCHOOL
RELEASE FORM
Child’s Name_________________________________
Parent’s/Guardian Names_______________________
Address______________________________________
City_________________St___________Zip_________
Home phone_______________Work_______________
Cell Phones___________________________________
Dear Parents:
It is EXTREMELY important for your child’s safety that we know who they can be released to after school. Please know that we CANNOT RELEASE TO ANYONE WHO IS NOT ON THIS LIST.
Only those named below are authorized to pick up_________________________(students name) other than listed parents/guardian from above.
1._________________Relationship_________Phone__________
2._________________Relationship_________Phone__________
3._________________Relationship_________Phone__________
4._________________Relationship_________Phone__________
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