Registration - Highlands Preschool & MMO

Child's Name

Date of Birth

What name does your child go by?

Gender

Address

City

State

Zip Code

Home Phone

E-mail Address

Mother's Name

Mother's Cell Phone

Father's Name

Father's Cell Phone

Does child live with both parents?

If no, list with whom the child lives and the marital status of that parent.

Name and ages of other children at home:

Did your child attend a Mother's Morning Out/ Day Care last year?

If yes, where?

Do you have a current church home?

If yes, where?

If you do not have a current church home, would you like some information about Highlands?

Emergency Contact Information & Pick Up Authorization
These people (other than parents) are authorized to pick up my child from preschool and can be contacted in case of emergency.

Name

Relationship

Phone

Name

Relationship

Phone

Name

Relationship

Phone

Name of Child's Doctor

Doctor's Phone

List any medical problems or allergies (speech, asthma, etc)

In case of an emergency or accident on the school/church grounds or during any school activity involving my child, if the parent is unable to be contacted and the injury, in the opinion of the MMO staff present, requires immediate medical attention,

I hereby grant permission to said MMO staff to obtain the services of a physician or to transport my child to the hospital as it is deemed necessary.

I hereby grant permission also, to said physician to treat said condition unless I am present and request otherwise.

Photography Release

We give Highlands Preschool & MMO permission to take photographs of our child.

We give Highlands Preschool & MMO permission to publish or display the photographs of our child in publications, websites, Facebook, or church bulletin boards. I understand that my child's name will not be published with the picture.

Enrollment
I wish to enroll my child in the following class: (please check one)

2 Year Class
3 Year Class (must be fully potty-trained prior to the first day of school)

Digital Learning

Digital Learning includes a weekly Zoom circle time.

Click here to view a sample Digital Learning lesson.

2 lesson plans per week - $10 per month

3 lesson plans per week - $15 per month

4 lesson plans per week - $20 per month

Play-Doh Mat Sets

Each paid registration receives a Play-Doh Mat Set for kinetic play and learning. Please choose which set you would like to receive in the mail.

ABC Play-Doh Mat Set

Numbers Play-Doh Mat Set

Shapes Play-Doh Mat Set

Parent Agreement

I have paid the required registration fee. Registration for Digital Only is $25.00. Registration for In Person when available is $100.00. I understand the registration fee is non-refundable and does not apply to tuition.

Click here to pay the registration fee.

I have read the Parent Handbook and agree to the terms set by the Parent Handbook.

Click here to read the Parent Handbook

I understand the Highlands Preschool & MMO program is not licensed by the state and has filed the proper exemption requirements with Bright From the Start Georgia Department of Early Care and Learning.

Parent Signature

Date

2020-2021 Application for Enrollment