Name:_________________________________________
Relation to Child:________________________________ Phone:_________________
Name:_________________________________________
Relation to Child:________________________________ Phone:_________________
Name:_________________________________________
Relation to Child:________________________________ Phone:_________________
Please Note: Another form (which you will receive after registration) will require photos of these individuals.
Physician:______________________________________ Phone:_________________
Insurance Company:______________________________ Phone:________________
ensures your child's placement in Discovery Corner Preschool (or on
a waiting list). Payment will be due on the first of each month based
on a daily fee of $13.00. It is assumed that your child will remain
in the program for the entire 2005-2006 school year. In the case that
your child would need to leave the program, a minimum of two weeks
notice is requested. It is the intention of Discovery Corner Preschool
to always have the best interest of the child in mind.
parent or legal guardian
___________________________________________________________________________________________
For office use only:
Enrollment Agreement received: Date:__________
$25.00 Registration fee received: Date:__________ Check#:__________
