Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Child's Address *

Residential Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Measles (Rubella) *

Yes

No

German Measles (Rubella) *

Yes

No

Chicken Pox *

Yes

No

Mumps *

Yes

No

Whooping Cough *

Yes

No

Is your child toilet trained for bladder? *Required for threes classes (Wonders and Explorers) *

Yes

No

Is your child toilet trained for bowel? Required for threes classes (Wonders and Explorers) *

Yes

No

Parent's Name *

First Name

Last Name

Primary Phone Number *

(###)

###

####

Secondary Phone Number

(###)

###

####

Parent's Name

First Name

Last Name

Primary Phone Number

(###)

###

####

Secondary Phone Number

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####

Pediatrician Phone Number

(###)

###

####

Date

MM

DD

YYYY

Morningside Day Out Preschool (MDO) agrees to provide education and care for my child during the hours of 9:00 am-1:00 pm from Monday, August 8, 2022 to Thursday, May 25, 2023 except for holidays, teacher work days, and other days as specified in the MDO calendar. *

I agree

I understand that MDO preschool has been operating as a non-licensed school since January 1979 and has exempt status from the state of Georgia. More information on license exempt programs can be found here https://www.decal.ga.gov/CCS/Exemptions.aspx *

I agree

I agree to pick up my child no later than 1:00 pm from MDO. If I do not retrieve my child by 1:00 pm I will be charged $1.00 for every minute that I am late. *

I agree

I understand that all tuition deposits and application fees are non-refundable and that monthly tuition must be paid in full by the first of each month regardless of wether or not my child attends. *

I agree

I will provide written authorization to allow anyone other than those listed on the information card to pick up my child from school. *

I agree

I acknowledge it is my responsibility to complete and sign the Confidential Information form (which includes Emergency Medical Treatment Permission) prior to the start of the school year. I also acknowledge it is my responsibility to keep my child’s record current to reflect any significant changes as they occur; e.g., telephone numbers, home and work locations, emergency contacts, child’s physician, child’s health status, immunization records. *

I agree

MDO agrees to keep me informed of any incidents, including illnesses, injuries, communicable diseases, etc., which involve or may affect my child. *

I agree

I agree to abide by the written policies and procedures of Morningside Day Out Preschool as outlined in the MDO Parent Handbook. *

I agree

I have access to and have read the Parent Handbook online or will ask for a hard copy from the MDO office. *

I agree

I understand that my child must be fully independently potty trained* before entering the Wonders, Explorers, or Pre-K class (turning 3+ on or before September 1, 2022) and that my child may be removed from the program if they are unable to use the restroom independently while enrolled in the above mentioned classes. *Independently potty trained is defined as initiating using the restroom, pull pants up/down, wipe, flush and wash hands without assistance. *

My child turns 3+ on or before September 1, 2022 and is independently potty trained as described above

My child will be younger than 3 on September 1, 2022

I understand that parent involvement in the school is integral to my child’s and the school’s success. The school relies on all parents to give time and talents to the activities that benefit the school, including fundraising events. I understand that each family is expected to honor their commitment to MDO by volunteering for and attending our major fundraising event(s). *

I agree

I give my consent for MDO to publish in print, electronic or video format image(s) or photograph(s) taken or recorded at MDO or any of its functions. I release all claims against MDO with respect to copy ownership and publication including any claim for compensation related to use of the materials. *

I agree

Confirmation *

I have read and understood the Parental Agreement.

Child's Name *

First Name

Last Name

Date *

MM

DD

YYYY