Greenleaf Friends Academy |

Step 1 of 5

Child's Information

Child's Full Name*

First Middle Last

Birthdate

Age

Male or Female

Male

Female

Parent Information

Parent's Address*

Street Address City State ZIP Code

Additional Address

Street Address City State ZIP Code

Medical

Allergies:*

Medical Issues:*

Current Medications:*

Emergency Contacts and Release Authorization

I give permission for my child to be released to the following individuals:

Full Name

Relation to Child

Phone

Full Name

Relation to Child

Phone

Agreement

Any individual picking up a child must show picture identification.

Agreements and Authorizations

1) I have received a Greenleaf Friends Academy Preschool and Daycare Parent Handbook and understand and agree to the policies and procedures contained therein.

2) I understand the tuition policies and take responsibility for tuition charges.

3) I authorize Greenleaf Friends Academy Preschool and Daycare to administer any needed first aid to my child.

4) We agree that if our child should become involved in any trouble with other children in the school we will refrain from complaining to other parents, but in the love of Christ and with prayer, we will register only the necessary complaints with the school

5) I acknowledge that Greenleaf Friends Academy Preschool and Daycare is a ministry of Greenleaf Friends Church and they will be part of the decisions and be involved in any disputes that may arise in the course of the preschool and its activities. If we have a concern about a situation at Greenleaf Friends Academy, we agree to follow the biblical model in Matthew 18, by first discussing the issue with the person directly involved. If the matter is not successfully resolved, we agree to follow the administrative chain of command, and finally the school board. We understand that this principle requires us to act with love and respect for the good of the school at all times and deters us from discussing the matter with anyone who is not part of either the problem or the solution.

6) I expressly waive, release and hold harmless, Greenleaf Friends Academy Preschool and Daycare and Greenleaf Friends Church, and each of its staff members or agents thereof, from any and all claims made by me or by my child concerning any and all liability, injury, loss or damages which may be suffered in any way connected to my child’s participation in Greenleaf Friends Academy Preschool and Daycare, save and except where such damages were caused by the gross negligence or willful or wanton misconduct of any staff member of Greenleaf Friends Academy Preschool and Daycare.

Consent

Parent's Signature*

Printed Name*

Date*

For Office Use Only:

Received By:

Date Received:

Registration Fee Paid:

Amount and Method:

Price Quoted:

Referred By:

Phone

This field is for validation purposes and should be left unchanged.

Application for Admission Daycare

Child's Information

Parent Information

Parent Contact

Daycare Requested

Parent Work Information

Parental Status

CHRISTIAN COMMITMENT

Additional Information

Medical

Emergency Contacts and Release Authorization

Agreement

Consent

For Office Use Only:

School Calendar