ENROLLMENT FORM

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Child's Name:

Birth Date:

Age:

Gender:
M F

NOTICE FOR PARENTS:

If child lives only with one parent, each parent must fill a separate Enrollment Form as per Texas State Law:

Child lives with:
Mother Father Both

Mother's Information

Last Name:

First Name:

Middle Name:

Street Address:

City:

Zip Code:

Home Phone:

Cell:

Personal e-mail:

Employer:

Work Phone:

ext:

Father's Information

Last Name:

First Name:

Middle Name:

Street Address:

City:

Zip Code:

Home Phone:

Cell:

Personal e-mail:

Employer:

Work Phone:

ext:

CONTACTS INFORMATION:

People to call in case of emergency, if parents may not be reached:

Name:

Relation:

Address:

Cell Phone:

Parent or legal guardian signature:

Date:

I hereby authorize Framboyant Learning Center to allow my child to leave the facility ONLY with the following persons. Children will only be released to a parent or a person designated by the parent/guardian after verification of ID.

Name:

Relation:

Address:

Cell Phone:

Parent or legal guardian signature:

Date:

UNDER NO CIRCUMSTANCES WILL YOUR CHILD BE RELEASED TO ANYONE THAT IS NOT AUTHORIZED BY PARENT OR LEGAL GUARDIAN IN THIS FORM. A MINIMUM OF 2 EMERGENCY CONTACT MUST BE REGISTERED IN THIS FORM AS PER THE STATE LAW.

AUTHORIZATION FOR EMERGENCY MEDICAL CARE:

In the event I cannot be reached to make arrangements for emergency medical attention, I authorize Framboyant Learning Center's Director or person in charge to take my child to:

Name of Physician:

Phone:

Address:

Name of Physician:

Phone:

Address:

I give consent for this facility to secure any and all necessary emergency medical care for my child and I understand that any expense incurred will be borne by the child's family.

Parent or legal guardian signature:

Date:

SPECIAL NEEDS:

List any special problems that your child may have, such allergies, existing illness, previous serious illness, injuries and hospitalizations during past 12 months, any medication prescribed for long-term continuous use, and any other information which caregiver's should be aware of:

OTHER AUTHORIZATIONS:

I hereby grant permission for my child to use all the play equipment and participate in all physical activities at the center.

Parent or legal guardian signature:

Date:

Framboyant Learning Center does not use a specific religion as a philosophy to educate our children, however during the school year, we celebrate diferent holidays doing activities along with the children to increase their general culture and social development, i.e. thanksgiving fest, birthday celebrations, among others.

Yes, my child is allowed to participate on any and all the activities related to any and all holidays and/or celebrations done at the center.

Parent or legal guardian signature:

Date:

I acknowledge receipt of the Framboyant Policy Statement for Enrollment.

Parent or legal guardian signature:

Date:

Admissions

ENROLLMENT FORM

ENROLLMENT FORM

NOTICE FOR PARENTS:

Mother's Information

Father's Information

CONTACTS INFORMATION:

AUTHORIZATION FOR EMERGENCY MEDICAL CARE:

SPECIAL NEEDS:

OTHER AUTHORIZATIONS: