Enrollment Form

* = Required Information

Annual Contract between Smarty Pants Pre-School LLC and the Parent/Guardian

Location *

I parent of have read and understand the information contained in this contract and I agree to fulfill the obligations and responsibilities of the terms listed below.

Please initial each line and sign and date the bottom

In return for my fulfillment of this agreement, Smarty Pants Pre-School LLC agrees to provide childcare services in accordance with the standards set forth in the Florida Administrative Code, Florida Statutes and the Florida Department of Children and Family Services.

I understand that a nonrefundable registration fee is required at the time of registration

I understand that a re-registration fee will be due annually at the beginning of the new school year.

I understand that tuition is an annual contract that is available to be broken into weekly payments and are paid in advance of services

Program	Annual Rate	Weekly Rate
6 weeks-12 months	$18,200.00	$350.00
1 year old	$18,200.00	$350.00
2 years old	$16,900.00	$325.00
3 years old	$16,900.00	$325.00
4 years old	$16,900.00	$325.00
VPK

I understand there will be a late payment of $50 if tuition payments are not received Friday morning at time of drop off.

I understand my child may be suspended or discharged for nonpayment.

I understand that if my child is not picked up by the close of business my child will be placed into an extended care program, and I will pay a fee of $50 for the occurrence.

I understand there is a return check fee of $40. And the returned amount including the fee must be paid in cash.

I understand my child is filling a limited enrollment and other children may be waiting or turned away for the position and Smarty Pants Pre-School LLC depends on my tuition payment to meet overhead obligations.

I understand there is NO reduction in tuition payments for holidays, emergency school closings, vacations, illness, or absences from the center for any reason.

I understand a two-week notice is required before withdrawing my child. If two weeks advance notice is not given, I will pay two weeks at the time notice is given.

By my signature I affirm that I understand and agree to the terms of this contract

Parent Printed Name *

Date of Signature *

Parent Signature *

Emergency Contact Information

Child's Name *

Date of birth *

Address *

Health concerns / Special instructions

Doctor's information

Name

Address

Telephone Number

Notification information

In case of illness or accident, contact the following:

Father/Guardian *

Phone Number

Cell Phone

(Phone Number or Cell Phone required)

Mother/Guardian *

Phone Number

Cell Phone

(Phone Number or Cell Phone required)

Two emergency contacts

#1 *

Phone Number *

#2 *

Phone Number *

I authorize Smarty Pants Pre-School to contact the persons identified on this form. I authorize the named physician or his associates to render treatment deemed necessary in an emergency. In the event no one can be reached in a timely manner, Smarty Pants Pre-School officials are hereby authorized to take actions they deem necessary for the wellbeing of my child.

It is understood that the expense of all actions will be accepted by me.

Parent/Guardian Signature *

Date *

Authorized Child Pickup Information

Name of child *

Age *

Birth Date *

Identification Details / Physical Description

Height

Weight

Color hair

Color eyes

Race

Other characteristics
Glasses - Scars - Piercing

Security Codes

Insert photograph

Insert code word *

Insert duress word *

Insert attendance code *

Parents/Guardians

Father/Guardian Name *

Mother/Guardian Name *

List the names of individuals authorized to pick up your child from Smarty Pants Pre-School. Children will not be allowed to leave the facility with anyone unless proper authorization from the parents/guardians is given. For security reasons, all persons authorized to pick-up children must have in their possession valid identification. All persons authorized to pick up children, including parents/guardians, and siblings are required to take a photograph that will be kept on file.

Authorized Pickup List

Name *

Phone number *

Relationship *

Parents/Guardians Signature *

Date *

Child Medical Alert Information

Child's name *

Age *

Does child have allergies? *

YesNo

If yes explain

Does child require special diet? *

YesNo

If yes explain

Does child require any special sleeping instructions? *

YesNo

If yes explain / physician authorization

Parents/Guardians Signature *

Field Trip General Authorization

Child's Name *

I am the parents/guardians of the above named child. I authorize Smarty Pants Pre-School officials to take my child on routine walks around the center.

I will be notified prior to and give specific permission for any trips scheduled away from the center.

If circumstances arise that my child cannot attend a scheduled field trip, I understand that there may not be school on that day.

Parent/Guardian Signature *

Date*

Permission to Photograph Child Form

I give my permission for photographed and/or videotaped by the staff of Smarty Pants Pre-School and the local media, approved by and accompanied by the Director, for the purposes of advertising, public relations, and family enrichment. The snap shots which may include my child can be published.

This photograph can be used for the purposes of advertising in the local business directory.

Parent/Guardian Signature *

Date*