dev_Registration – Love 4 Learning Preschool

Child Name *

Name that student goes by (nickname) *

School Year *

Select Session * Two Days/Week Three Days/Week

Date of Birth *

Gender * Boy Girl

Preferred Hand * Right Left

Additional Information about the child (i.e. food allergies, health issues, etc.)

Would you like your child to attend Love 4 Learning Preschool two years? (This does not guarantee enrollment for both years.)

PARENT (LEGAL GUARDIAN) INFORMATION

Parent 1 - First Name *

Parent 1 - Last Name *

Parent 2 - First Name

Parent 2 - Last Name

Phone *

E-Mail *

I regularly check this email? *

Street Address *

City *

State *

ZIP Code *

Hobbies or professions you would be willing to share with the class (i.e. dentist, policeman, foreign country, etc.)

EMERGENCY CONTACT

Full Name *

Relationship *

Phone *

Street Address *

City *

State *

ZIP Code *

WAIVER

I agree, for myself and for my child, to the following:

I wish to enroll my child in Love 4 Learning Preschool
I realize that while attending Love 4 Learning Preschool my child will be supervised by a teacher or assistant teacher during the time they are at school.
I understand that Love 4 Learning Preschool has attempted to create an injury-free play area for my child; however, I acknowledge that young children may get hurt while playing with other children and while engaging in physical activities, and that there is a risk of property damage, serious injury or death inherent in my child participating in preschool classes and activities.
I also understand that there are risks inherent in any physical activity program, including the use of equipment such as those provided for use at Love 4 Learning Preschool which may or may not be obvious and which may pose serious threats to any person if used improperly.
In the event my child becomes injured while participating in activities, I hereby consent to Love 4 Learning Preschool to provide First Aid as well as summoning medical professionals to administer First Aid or emergency medical treatment for my child.
I agree to follow any instructions or rules established by Love 4 Learning Preschool with regard to my child’s activities, whether written or orally given by Love 4 Learning Preschool.
I understand that every child is in a unique developmental stage and that I am most familiar with my child’s capabilities and limitations. As such, I agree to discuss any concerns with Love 4 Learning Preschool that I have about my child which I think may affect my child’s ability to safely participate in any activities or to use any equipment.

(Please Check all boxes that apply)

I am not aware of any physical or other condition which may affect my child’s ability to participate in any activity at Love 4 Learning Preschool

I am aware my child suffers from the following physical or other conditions which may affect their involvement at Love 4 Learning Preschool

List any physical impairments of any child who will be participating in Love 4 Learning Preschool classes

I agree not to hold Love 4 Learning Preschool in its entirety responsible for any injuries suffered by my child while involved in activities at preschool.
I agree to RELEASE, DISCHARGE, IDEMNIFY, PROMISE NOT TO SUE, AND TO SAVE AND HOLD HARMLESS Love 4 Learning Preschool in its entirety from liability, damage, or costs whatsoever arising out of or related to any loss, damage, or injury (including death) to me or my child arising out of or in any way connected with participation in the activities of Love 4 Learning Preschool for any reason or cause.
I understand and agree that this release and waiver of liability, assumption of risk, and hold harmless agreement is governed by the laws of the State of Utah and is intended to be as broad and inclusive as is permitted by such law, and that, in the event of any portion of this agreement is determined to be invalid, illegal, or unenforceable, the validity, legality, and enforceability of the balance of the agreement shall not be affected or impaired in any way, and shall continue to full legal force and effect. This release and waiver of liability shall be enforced and interpreted only by binding arbitration in Cache County.
PARENT/GUARDIAN AUTHORIZATION
Please list any restrictions to the permission of the following:

My child may be taken on field trips or excursions by bus or private motor vehicle, as well as on neighborhood walking excursions under required supervision
My child may participate in swimming or other water activities under required supervision.
My child may be photographed for publicity or news purposes
My child may be given non-prescribed medication as indicated on the container. This may include sunscreen, childrenss pain reliever, antibacterial first aid cream, syrup, or ipecac may be administered if deemed necessary by the poison control operator. The childss parent or guardian will be contacted prior to administering non-prescribed pain relievers. Prescription medications must be current and a permission slip is required for each medication.
In an emergency, Love 4 Learning Preschool has my permission to call an ambulance or take my child to any available physician or hospital at my expense to obtain medical treatment. In most emergencies, 911 is called and the child is transported to the nearest hospital and treated by the on-call physician. The Parent or guardian of the child is notified as soon as possible.

I HAVE READ THIS DOCUMENT AND AGREE TO ALL OF ITS TERMS. I UNDERSTAND IT IS A LEGALLY BINDING AGREEMENT AND WAIVES CERTAIN LEGAL RIGHTS OF MINE, INCLUDING, BUT NOT LIMITED TO A RELEASE, WAIVER, PROMISE NOT TO SUE, AND A HOLD HARMLESS FOR ALL CLAIMS. THIS AGREEMENT SHALL BE BINDING UPON ME, MY CHILD, AND OUR ESTATE, SUCCESSORS AND ASSIGNS.

I understand my child must be 3 by July 1st and is FULLY potty trained. *

By checking this box I agree that I have filled out this form to the best of my ability and agree with all that has been stated. *

Parent/Guardian Printed Name *

Auth Code *

- Jennifer Schmidt

a child can develop is a deep love for learning."

"As a former kindergarten teacher, I believe that one of the most important traits

Love 4 Learning Preschool

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STUDENT REGISTRATION FORM