Little Red Wagon Preschool
Enrollment Checklist
We are excited you are going to join us for the 2015/16 school year. Please make
sure you turn in everything listed below in order to complete your child’s enrollment.
You will receive a confirmation letter/email of enrollment by the end of February
(though we will aim to confirm with you as soon as possible).
ENROLLMENT CHECKLIST:
Student Enrollment Form
Class Preference/ Tuition Agreement Form
Permission/Release Form
Supply Fee + Registration Fee (see explanation below)
ANNUAL SUPPLY FEE (non-refundable)
This fee accounts for art and crafts, snacks and activities for the year. This is an
annual fee for each child. This is due at time of enrollment.
2 Days: $55
3 Days: $80
5 Days: $130
ANNUAL REGISTRATION FEE (non-refundable)
This assists in paying for operating expenses and curriculum materials. This is an
annual fee for each family. This is due at time of enrollment. $75
TOTAL DUE AT ENROLLMENT:
Supply Fee (see above) + Registration Fee ($75)
EXAMPLE A: 1 CHILD, 2 DAYS A WEEK
$55 (supply fee 2 Days a Week)
$75 (registration fee)
Total: $130
EXAMPLE B: 2 CHILDREN, 3 & 2 DAYS A WEEK
$80 (supply fee, 3 Days/Wk Child 1)
$55 (supply fee, 2 Days/Wk Child 2)
$75 (family registration fee)
Total: $210
LAST MONTH’S TUITION PAYMENT (non-refundable)
Half Tuition for June 2016 will be due by Friday, April 17, 2015
nd
2 Half tuition for June will be due by June 1, 2016.
Full September tuition will be due by the first day of school.
1st
Little Red Wagon Preschool
Tuition Schedule 2015/16
TUITION SCHEDULE
Little Red Wagon Preschool’s academic year runs September through mid-June.
Annual tuition is based on the academic school year and is divided into 10 monthly
payments for your convenience. We have taken holidays and vacations into account.
Our expenses are constant and our enrollment is limited. If at any point you need a
special payment plan, please contact the Director to arrange.
T/Th& M/W 2/3’s Class
T/Th Mixed 3-5’s Class
MWF 3/4’s Class
MWF 4/5’s Class
5 Days (MWF + T/Th)
$350/mo
$325/mo
$425/mo
$425/mo
$625/mo
Tuition is due on the 1st of the month and will be considered late if not received by
the 10th. A $15 late fee will be added to all tardy payments. A $25 insufficient
funds fee will be charged to returned checks. Payment should be in the form of cash
or check; we cannot process credit cards.
SIBLING DISCOUNT
There is a 10% discount on the 2nd child’s tuition when siblings are simultaneously
enrolled. First student is full tuition; second student is 10% off (3rd or 4th would also
be 10% off).
WITHDRAWL
If it becomes necessary to withdraw your child, at least one-month written notice
submitted to the Director is required.
LAST MONTH’S TUITION PAYMENT (non-refundable)
1st Half Tuition for June 2016 will be due by Friday, April 17, 2015
2nd Half tuition for June will be due by June 1, 2016.
Full September tuition will be due by the first day of school.
FEEL FREE TO REMOVE AND KEEP
THIS SHEET FOR YOUR REFERENCE
Little Red Wagon Preschool
Class Preference & Tuition Agreement
Please X which class you would prefer your child to be enrolled in. We create classes
with currently enrolled families first, then fill remaining spots with new families.
We will confirm enrollment by February.
CHILD’S NAME:
CLASS PREFERENCE: (PLEASE MARK WITH AN X )
T/TH
2/3’s Class
M/W
2/3’s Class
T/TH
3-5’s Mixed Class (must be 3 by August 31)
M/W/F 3/4’s Class
M/W/F Pre-K
M–F
3/4’s + T/Th (*Priority enrollment is given to PreK students for 5 days)
M -F
Pre-K + T/Th
ADDITIONAL INFORMATION: (ie: Friend to be in same class, waiting list/2nd choice, etc):
I PLAN TO SEND MY CHILD TO KINDERGARTEN IN FALL OF 20____
TUITION AGREEMENT:
I have read the tuition schedule and understand that payment is based on a yearly
basis broken down into 10 monthly payments. All tuition payments are due on the
1st of the month and a late charge of $15 will be assessed for payments received
after the 10th of the month. I understand that if it is necessary to withdraw my
child from Little Red Wagon Preschool for any reason, at least one month written
notice to the Director is required. I also understand that the registration, supply
and/or waitlist fee, as well as tuition payments are non-refundable and nontransferable.
Parent/Guardian Signature:
Date:
OFFICE USE ONLY
Name:
Days:
Little Red Wagon Preschool
Registration Form 2015/16
Teacher:
Allergy
Application Rec’d
Permission Rec’d
Tuition Agreement
Supply Fee
Registration Fee
Sept Tuition
Emergency Kit
CHILD’S NAME:
NAME USED/NICKNAME:
BIRTHDATE:
MOTHER/GUARDIAN:
FATHER/GUARDIAN:
HOME ADDRESS:
HOME PHONE NUMBER:
MOM’S CELL NUMBER:
DAD’S CELL NUMBER:
MOM’S EMAIL:
DAD’S EMAIL:
MOM’S EMPLOYER:
DAD’S EMPLOYER:
MOM’S WORK NUMBER:
DAD’S WORK NUMBER:
SIBLING’S NAME
BIRTHDATE
EMERGENCY CONTACTS
1. NAME:
RELATIONSHIP
ADDRESS:
HOME PHONE:
2. NAME:
RELATIONSHIP
ADDRESS:
HOME PHONE:
SCHOOL
CELL PHONE:
CELL PHONE:
OTHER THAN YOU, WHO HAS PERMISSION TO PICK UP YOUR CHILD?
RELATIONSHIP
NAME
HEALTH INFORMATION
CHILD’S HEALTH CARE PROVIDER:
TELEPHONE
ADDRESS:
SPECIAL HEALTH PROBLEMS:
ALLERGIES (FOOD, ENVIRONMENT, DRUG REACTIONS):
REGULAR MEDICATIONS:
PREFERRED HOSPITAL IF TREATMENT IS NEEDED:
NAME OF INSURANCE COMPANY:
MEMBER/POLICY NUMBER:
NAME OF POLICY HOLDER:
EMPLOYER:
CONSENT TO MEDICAL CARE AND TREATMENT OF MINOR CHILDREN
I give permission that my child, _______________________________________, may be given emergency treatment by a
qualified care provider. When I cannot be contacted, I authorize and consent to medical, surgical and hospital care,
treatment and procedures to be performed for my child by a licensed physician, health care provider, hospital or aid
medical attendant when deemed necessary or advisable by the physician or aid to safeguard my child’s health. I waive
my right of informed consent to such treatment.
I also give my permission for my child to be transported by ambulance or aid car to an emergency center for treatment.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and
correct:
PARENT OR GUARDIAN SIGNATURE:
DATE:
PARENT OR GUARDIAN SIGNATURE:
DATE:
ADDRESS:
PHONE NUMBER:
Little Red Wagon Preschool
Permission Authorization
CHILD’S NAME:
Little Red Wagon Preschool has my/our permission:
1. Take my child on walks around the neighborhood
Yes No
2. Take photos of my child (this is only for classroom use)
Yes No
3. Give my telephone, email and address to other parents
Yes No
4. Use my child’s artwork, picture or words
on the Little Red Wagon website or on materials
promoting Little Red Wagon preschool (ie: brochure)
Yes No
PARENT/GUARDIAN SIGNATURE
DATE: