Registration Form Student Name * First Name Last Name Age * Birth Date * MM DD YYYY Which class are you registering for? * Preschool (W/F) Pre-K (M,T,Th) AM Pre-K (M,T,Th) PM Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Please list all family members living in the home. Include ages of siblings. * Parent Name * First Name Last Name Relationship to Child * Mother Father Grandmother Grandfather Stepmother Stepfather Legal Guardian Phone * (###) ### #### Email * Home Address (if different from student's home address) Parent Name * First Name Last Name Relationship to Child * Mother Father Grandmother Grandfather Stepmother Stepfather Legal Guardian Phone * (###) ### #### Email * Home Address (if different from student's home address) Do you wish for both parents to receive our monthly newsletter and other school communications? * Yes No Which parent should be the primary contact to receive payment information and important school information and updates? * Tell us about your kiddo! What is his/her personality like, interests, strengths, challenges, etc. * Does your child have any allergies? If so please list them and give a detailed description of their treatment plan if they are exposed to an allergen. * Does your child have any conditions or diagnosis that require medical care, attention or treatment? If so, please give a detailed description here: * Does your child require the administration of medication during his/her school day? If so, please list the medications and their instructions here: * Does your child have any social or emotional challenges that might require additional support from teaching staff? If so, please explain: * Do you have any concerns about your child attending school? * Emergency Contact (other than parents) * First Name Last Name Phone * (###) ### #### Relationship to child * Is this person authorized to pick up your child from school? * Yes No Emergency Contact (other than parents) * First Name Last Name Phone * (###) ### #### Relationship to child * Is this person authorized to pick up your child from school? * Yes No The Little School of Snohomish will always require prior parental permission and check ID for any unknown adult picking up your student. However, is there anyone who is explicitly NOT allowed to pick your child from school? * Is there anything else you would like us to know about your student or family that will help us make the school year a success for your child? * Have you reviewed and agree to our terms of service? * Yes I understand that submitting this registration form does not guarantee my child's classroom spot at The Little School of Snohomish. I understand that I may be required to tour the school prior to enrollment if I have not yet done so. I understand that enrollment is subject to availability and understand that my child's spot is not held until my payment is processed as determined by the service agreement. * Yes I understand that my submitting this form I am agreeing to sign electronically. Paper signatures can be accommodated by written request. * Yes Electronic Signature * First Name Last Name Date of Signature MM DD YYYY Thank you for submitting your registration! We will contact you shortly with payment instructions and next steps!