Little Stars Arts Academy Admissions Form
This is the 2nd step to the application process. Please make sure you also click the "register now" link to create a Studio Director account, officially register and add payment form.
Email *
Child's Full Name *
Parent/Guardian's Full Name *
Did you already make a Studio Director account? *
Authorized Pickup: I hereby authorize the childcare operation to allow my child to leave the childcare operation ONLY with following persons. Please list name and telephone number for each. Children will only be released to a parent or a person designated by the parent/guardian after verification of ID.
TRANSPORTATION: I herby give/do not give consent for my child to be transported by the operation’s employees for emergency care. *
WATER ACTIVITIES: I herby give/do not give consent for my child to participate in water table play. *
PARENT HANDBOOK: I acknowledge receipt of the facility’s operational policies including those for discipline and guidance. *
FOOD: I understand that the following meals will be served to my child while in care *
IMMUNIZATION: I have provided the childcare operation with a copy of my child’s most current immunization record OR I am excluding my child from the immunization requirements for reasons of conscience, including religious belief. I have attached an official notarized affidavit form developed and issued by the Department of State Health Services. I understand this affidavit is valid for 2 years. *
CHICKENPOX: My child has/has not had chickenpox. The varicella (chickenpox) vaccine is not required if your child has had chickenpox disease. If your child has had chickenpox, please complete the following statement. *
ALLERGIES: My child has/does not have an allergy to a food that has been diagnosed by a physician. I will provide the childcare operation with a Food Allergy Emergency Plan signed by myself and my physician. *
If you child has allergies, please list them below.
Authorization for Emergency Medical Attention: In the Event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to. Please list physician name, medical facility, address and phone number. *
List any special problems that your child may have, such as allergies, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregiver’s should be aware of.
If your child does not attend pre-kindergarten or school away from the child-care operation, one of the following must be presented when your child is admitted to the child-care operation or within one week of admission. Please pick which option you will provide. *
DISCLAIMER: While we would love to provide a space for every child, some children have needs that are beyond the scope of our ability to provide services. Our ability to provide childcare/school services will be determined by the owner of Prep Academy Dance Studio and instructor an individual basis
I acknowledge that I have received a copy of the Parent Handbook. I understand that it replaces and supersedes any prior version of the handbook. I will familiarize myself with the material in the Parent Handbook, and I understand and acknowledge that I am responsible for knowing and abiding by its contents. *
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