Preschool Prep Registration - Meridian Learning

Student Information

Parent's Name:*

First Last

Parent's Name:

First Last

Number of children you are registering:*

Please enter a number from 1 to 3.

1-3

Child's Name:*

First Last

Child's Date of Birth:*

2nd Child's Name:*

First Last

2nd Child's Date of Birth:*

3rd Child's Name:*

First Last

3rd Child's Date of Birth:*

Mailing address:*

Street Address Address Line 2 City State ZIP Code

Email address:*

Enter Email Confirm Email

Best Number to Reach You (choose one):*

Cell

Home

Work

Home Number:*

Cell Phone:*

Work Phone:

Student(s) Medical Information

Does your child have any allergies? Specific dietary needs/food sensitivities? Medical conditions?*

Is your child currently taking any medications?*

Yes

Please list medications:*

Has your child had recommended immunizations?*

Yes

If not, which ones have yet to be administered?*

Has your child had a recent vision and hearing test?*

Yes

Does your child have any special needs?*

Does your 2nd child have any allergies? Specific dietary needs/food sensitivities? Medical conditions?*

Is your 2nd child currently taking any medications?*

Yes

Please list medications:*

Has your 2nd child had recommended immunizations?*

Yes

If not, which ones have yet to be administered?*

Has your 2nd child had a recent vision and hearing test?*

Yes

Does your 2nd child have any special needs?*

Does your 3rd child have any allergies? Specific dietary needs/food sensitivities? Medical conditions?*

Is your 3rd child currently taking any medications?*

Yes

Please list medications:*

Has your 3rd child had recommended immunizations?*

Yes

If not, which ones have yet to be administered?*

Has your 3rd child had a recent vision and hearing test?*

Yes

Does your 3rd child have any special needs?*

Photo Release

Permission:

I/We give permission for photos/videos to be taken of:

Child's Name:

First Last

2nd Child's Name:

First Last

3rd Child's Name:

First Last

while he/she is participating in Meridian Montessori activities. I/We understand that photos/video may be published online, in printed materials and/or for other promotional purposes, but only to help document student work and illustrate Meridian Learning programs. I/We hereby waive any ownership rights, as well as any right that I/we may have to inspect or approve the finished product in which a photographic or video image may be used including the advertising copy or other matter that may be used in connection therewith or the use to which it may be applied.

Parent Agreement

Tuition:*

Price:

3 week session - 2 days per week (6 Classes) 10 am to 12 noon

Coupon Code:

Paypal Total:

Preferred Days:*

Monday

Tuesday

Wednesday

Thursday

Confidentiality

Meridian Learning is committed to protecting the privacy of all families who participate in our programs, as well as the children in the learning environment. With this in mind, we will not discuss confidential information in the presence of children or other parents. If you wish to discuss sensitive issues pertaining to your child, please contact us via email.

Attendance/Punctuality, Inclement Weather and Make-ups

Whenever possible, please give a two (2) hour notice if you are unable to attend class. We regret that we cannot excuse you from payment or grant refunds for absences. If available, a family may attend another preschool prep class in lieu of the missed class. Advanced notice of tardiness is appreciated as it may impact the rhythm of the class. If your child’s class is cancelled due to inclement weather or illness, a make-up class will be offered.

Student Behavior

We reserve the right to terminate enrollment at any time should a student’s behavior/needs, consistently and beyond an initial adjustment period, impact the quality of the environment, interfere with the functioning of the class as a whole and/or endanger the student or others.

Student Information, Medical Information, Photo Release & Parent Agreement Acknowledgement:*

By signing below, you are agreeing that the information provided is accurate and that you have read the Photo Release and Parent Agreement. My signature below indicates that I agree to all of the above provisions regarding my family’s participation in the program.

Parent/Guardian Name:*

First Last

Parent/Guardian Signature*

Parent/Guardian Name:

First Last

Parent/Guardian Signature