Katrina Trask Nursery School
24 Circular Street
Saratoga Springs, New York 12866
(518) 584-8968
Parent Information Form
This form helps the teachers plan a program to meet the needs of the children in each class.
If more space is needed, please attach additional pages to this form.
Contact information will be used for shared class lists: all other information will be kept otherwise confidential.
Class :
3’s
Child’s full name
4’s
Date of birth:
Home address:
Phone number for primary contact:
Email for primary contact:
Father’s name:
Occupation:
Work number:
Cell Number:
Employer/Address:
Previous Occupation if Currently a Stay-at-home Dad:
Mother’s name:
Occupation:
Work number:
Employer/Address:
Previous Occupation if Currently a Stay-at-home Mom:
Child care provider’s name:
Phone number:
Address:
Sibling’s names and ages:
Pets/others living at home:
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
Cell Number:
Does your child have any allergies?
Is medication required during school hours?
Does your child have any other medical conditions that the teachers should be aware of?
Has (or is) your child received any special services (physical, occupational, or speech)?
Are there any needs/concerns/fears that your child has that you would like the teachers to be aware of?
Please list any other information you feel would be important for the teacher to know to help your child in school.
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
Photo Release and Field Trip Consent Form
Throughout the year at Katrina Trask Nursery School, there will be several occasions in which your child’s photo,
or video, might be taken. The photos are used to create an end of the year scrapbook for your child to keep.
The teachers may also use the photos in class projects. Additionally, your child’s image may be utilized by our
publicity committee in our website, social media, newspapers, etc. to generate publicity for our school
Throughout the year the school participates in theme related field trips. You will be notified in advance of each
trip.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -By signing below you grant permission for your child’s photos to be used in school-related projects and
publicity and for Katrina Trask Nursery School to take your child on field trips.
Please note any exceptions to these policies in the space below.
Parent/Guardian Signature
(Field Trips)
Date
Parent/Guardian Signature
(Photo release for publicity)
Date
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
Emergency Contact and Child Release
Class :
3’s
4’s
Mother:
Cell #:
Home:
Work:
Father:
Cell #:
Home:
Work:
Please list two local people we may call if you cannot be reached.
Name:
Relationship:
Phone Number:
Cell phone:
Name:
Relationship:
Phone Number:
Cell phone:
Pediatrician:
Phone number:
*If a child’s parents or pediatrician cannot be reached, he or she will be taken to Saratoga Hospital.
Please see the Health and Safety Policies in the Parent Handbook for more information.
We, the parents/guardians of
,
Give permission for the following people to pick our child up from school:
Name
Relationship
1.
2.
3.
4.
5.
Parent/Guardian Signature
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
Date
Task Selection Form
Katrina Trask Nursery School encourages and welcomes the help of parents. If you are interested in any of the committee’s below your help,
experience and expertise is always welcome.
Class :
Child’s name:
Very Interested
Committee Name
Rank All 1-5
(see above)
Parents’ name(s):
Neutral
2
3
1
Mom/Dad
3’s
4’s
No Interest
4
5
Coordinator/Asst. Coordinator
(please note prior experience here as well)
Class Representative
Fundraising
Publicity
Secretary
Question…
Do you hold a teaching certificate &
would you be willing to sub if necessary?
Do you have experience with website
design or management?
Do you sing, play an instrument, or have
any other talents/hobbies you are willing
to share?
Other (Please let us know if there is
anything you would like to do to help the
school)
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
YES
NO
If YES, please provide details…
Committee Descriptions
Class Representative
Organizes telephone chain within the class
Helps arrange for special events in the classroom near holidays and assist with the acknowledgements of special events in
the lives of KT families.
Coordinates summer play dates and parent socials
Fundraising
This committee works with the KT Director in organizing all fundraising events at school, recommends projects and dates for
fundraising events. The fundraising chair(s) for each event are responsible for the operation of the fundraising event they
sign up to chair. Fundraising events include but are not limited to: Fall and Spring Consignment Sale, Original Works, Small
Hands, Flower Power. The committee sends all reports to the Director.
* Parents are not required to work on any committees, except with the exception of our major fundraisers such as the KT
Kids Consignment Sale.* Every family has to either work 10 hours per sale or pay the opt out fee as stated in the Parent
Contract. Major fundraisers take a lot of people working together to make the events successful. Any help with
fundraising is GREATLY appreciated by the school.
Publicity
This committee assists the KT Director in publicizing KT activities such as: fund-raising events, registration information, and
Open Houses. The members of this committee will work closely with the fundraising committee to publicize the consignment
sales and other major fundraisers. Committee members will assist the Director develop necessary promotional materials
such as flyers and posters and help with distribution of materials. This committee may also be asked to help with contacting
the newspapers about upcoming events. The committee will keep a record of all publicity.
Secretary
The Secretary will keep minutes of all monthly parent meetings. Minutes will be emailed to all of the parents and a copy will
be posted in the mailroom within one week of the meeting.
YOU MAY KEEP THIS COPY OF COMMITTEE DESCRIPTIONS AS A REFERENCE.
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
Katrina Trask Nursery School
24 Circular Street
Saratoga Springs, New York 12866
(518) 584-8968
Parent Contract
By signing this contract we are enrolling our child,
We will participate and fulfill the following duties:
Class: 3’s
4’s
, in Katrina Trask Nursery School

We understand that any tuition discount that we are given will be applied to the last tuition payment of the 2017-2018 school year.

We agree to pay the (non refundable $100 registration fee, $50.00 if registered by Jan 30, 2017) and yearly tuition of (Please Circle) 3’s
class $1700 or 4’s class $2130. The registration fee is due when you enroll your child. First tuition installment is due by May 1, 2017. The
remainder of the tuition payments will be paid on the last day of every month beginning on August 1, 2017. Please list here any alternate
payment schedules agreed upon between parents and the
school:
*Your $100.00 registration fee will hold your child’s spot until May 1st when the first tuition payment is due. If your first tuition payment is not
made, your spot will be forfeited.

We understand that in the event of early withdrawal, every attempt will be made by KT to fill the vacancy in order for the family to receive a
prorated refund. If the vacancy cannot be filled, the family will forfeit the paid payments and be responsible for any remaining tuition.

We will support and volunteer for the Fall and Spring Consignment Sale for 10 hours per sale. If we are not able to donate our time to
volunteering for the school’s major fundraiser we will pay the “consignment sale opt out fee”
I choose NOT to participate in the fall AND spring consignment sales. Instead I agree to pay the “opt out” fee of $500.00 for the year.
sale:

I choose not to participate in either fall OR spring sale (circle one). Instead I agree to pay the “opt out” fee of $250.00 for the following
.
We will provide all current immunization records for our child prior to the start of the school year or we understand that our child will not be
permitted to start school. In addition, we will keep the school informed throughout the year of any medical changes pertaining to our child’s
health.
We understand that the first two months the child is in school is considered a probationary period. At the end of that period, if the teacher(s) feel that a
satisfactory adjustment cannot be made, Katrina Trask Nursery School may cancel this contract and a prorated refund will be made to the parents.
Katrina Trask Nursery School may cancel this contract at any time for failure of the parents to adhere to the terms of the contract.
(Father’s Signature)
(Date)
(Mother’s Signature)
(Date)
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
The Saratoga Hospital
Emergency Department (518) 583-8313
Emergency MedicalAuthorization
If your child needs medical, dental, health, or hospital services, under the law, you as parent must
give your permission as the need arises. By law a hospital is always required to attempt to contact
parents and/or legal guardians to gain consent for treatment. This form can provide valuable
information to health care providers for contacting parents or guardians. The hospital still, however,
has the obligation to always attempt to contact parents or guardians. Medical care often requires
complex decisions that are best made when parents or guardians are involved. When a true
emergency exists, a child may be treated without parental consent. This will happen only when a
physician determines that a child needs immediate medical care and an attempt to obtain parental
consent would result in a delay which would increase the risk to the child’s life or health.
As Parent/Legal Guardian of (name of child)
,
I hereby authorize (name of caretaker)
residing at
(H) phone #
(W) phone #
to grant consent to medical doctors and emergency staff at a hospital/emergency facility to conduct
the required tests and provide necessary medical treatment/care to the above named child IF I OR
MY SPOUSE CANNOT BE REACHED.
Child’s date of birth
Date of child’s last Tetanus immunization
Pertinent medical data: (Allergies, asthma, seizures, etc. Also include any medication the child is
on, relative to this condition)
Medical restrictions
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
This authorization expires 12 months from:
(Today’s Date)
(over)
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
Emergency Medical Authorization con’t—
Name of Parent/Legal Guardian
Mother’s name
Father’s name
Home address
Home address
Home Telephone
Home Telephone
Place of employment
Place of employment
Work Telephone
Work Telephone
Parents/Legal Guardian
Parents/Legal Guardian
Signature
Signature
Date
Date
Printed name
Printed name
If medical advice or additional information on the child is required, please contact the following
physicians:
Pediatrician/Family physician
Dentist
Address
Address
Telephone
Telephone
Orthopedist
Surgeon
Address
Address
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
Telephone
Telephone
Medical Insurance Information
Guarantor (person responsible for payment of bill):
Name of Insurance
Policy Number
Note to Caretaker/Baby-sitter: if you have any trouble contacting me, the following name and
telephone number is of a friend/neighbor/relative/co-worker who might be able to contact me or
know where I am.
This is for information only.
Name
Form 3000 (Rev. 4/04) Saratoga Care, Inc.
Telephone