Please indicate your preference for number of program days and preferred schedule below:
5 Days (M-F)
3 Days (M,T,W)
2 Days (Th, F)
Other
Morning program (8:30 - 12:00)
Afternoon Program (12:00 - 3:30)
Before School Care (7:30 - 8:30)
After Care (3:30 - 4:30)
5 Days (M-F)
3 Days (M,T,W)
2 Days (Th, F)
Other
Morning program (8:30 - 12:00)
Afternoon Program (12:00 - 3:30)
Before School Care (7:30 - 8:30)
After Care (3:30 - 4:30)
Clear selection
If you selected "other" above, please explain:
Your answer
$25 Application Fee is in the mail
Clear selection
Parent/Guardian #1
Name *
Your answer
Pronouns *
Address *
Your answer
Home Phone *
Your answer
Email *
Your answer
Place of Work *
Your answer
Work/Cell Phone *
Your answer
Parent/Guardian #2
Name *
Your answer
Pronouns *
Address - if different from above
Your answer
Home Phone - if different from above
Your answer
Email *
Your answer
Place of Work *
Your answer
Work/Cell Phone *
Your answer
Name up to three family members/friends (other than parents/guardians) who have permission to pick up. Please include full name, relationship to child, and their phone #, e.g. First Last, Grandmother, 777-777-7777
Your answer
Emergency Information
Child's Doctor Name *
Your answer
Child's Doctor Phone Number *
Your answer
Child's Dentist Name *
Your answer
Child's Dentist Phone Number *
Your answer
Name of Hospital you would prefer you child to receive care: *
Your answer
Allergies *
Your answer
Does your child require an epi-pen? *
Emergency Contacts
If the parent/guardians are not available, who should we contact, in order of priority?
Emergency Contact # 1 Name *
Your answer
Emergency Contact #1 Relationship to Child *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact # 2 Name *
Your answer
Emergency Contact #2 Relationship to Child *
Your answer
Emergency Contact #2 Phone Number *
Your answer
Emergency Contact # 3 Name *
Your answer
Emergency Contact #3 Relationship to Child *
Your answer
Emergency Contact #3 Phone Number *
Your answer
By typing my name below, I authorize the staff of Timson Hill Preschool to administer medical treatment for my child in the case of a medical emergency when/if I cannot be reached. I also authorize the staff of Timson Hill Preschool to contact an ambulance when considered necessary for my child, in the case of an emergency and I cannot be reached.
Parent authorization (type name below & date)
Your answer
I give permission for the staff of Timson Hill preschool to give/apply the following non-prescription medication and or protectants if necessary:
Yes
No
First Aid Cream
Sunscreen
Insect Repellent (DEET Free)
Yes
No
First Aid Cream
Sunscreen
Insect Repellent (DEET Free)
Parent Name & Date authorizing above permission
Your answer
Getting to Know your Child...
Please list any fears your child may have that we should be aware of. *
Your answer
Does your child have any health problems we should be aware of? *
Your answer
What activities does your child enjoy? (Books, Sensory, Art, Puzzles, Playdough, Blocks, etc.) *
Your answer
Does your child have any sleep issues? Do they nap? Please describe: *
Your answer
Does your child take any medications on a regular basis? Please list: *
Your answer
Does your child have any dietary needs? Vegetarian? Please list: *
Your answer
Are there any other concerns or comments about your child that you think would be helpful to the school to know? *
Your answer
Are there any special beliefs/culture in your family that we should be aware of? *
Your answer
Who lives in the child’s house? Include pets: *
Your answer
What holidays do you celebrate? *
Your answer
Does your child use the toilet on their own? *
Your answer
Thank you for your interest in Timson Hill Preschool. Please make a copy of this form for your records. Once accepted, you will receive a parent handbook, contract, and annual permission slips. A School Calendar and other relevant information will be sent home.
A deposit of $100 will be due upon acceptance to the program to finalize your registration. All deposits will be applied to your school account in June 2022 once all school fees and contract obligations have been fulfilled.
Please provide a copy of your child’s most recent physical, immunization records, and insurance card upon acceptance into the program.
If you have any questions, please contact the director or any board member. Thank you for your interest in Timson Hill Preschool. We look forward to a successful year learning and growing with your child!
Timson Hill Preschool is an equal rights institution, and does not discriminate against any person based on race, national origin, creed, faith, mental or physical challenges, or sexual orientation.