TINY TREASURES NURSERY SCHOOL 2011-2012 APPLICATION


Child's Name         ___________________________________________________
Date of Birth           ___________________________________________________  Age in Sept.   ____________
Street Address       __________________________________________________________________________
Town                       ________________________________Zip  _________________
Mother's Name     ___________________________________________________   Phone (work)____________
Address (if different)_________________________________________________   Phone (home)____________
Occupation            ___________________________________________________   Phone (cell)_____________
Father's Name     ____________________________________________________  Phone (work)____________
Address (if different)_________________________________________________   Phone (home)____________
Occupation          ____________________________________________________   Phone (cell)_____________
Emergency Contacts (other than parents): 
(1) Name              ____________________________________________________    Phone__________________
Address              ____________________________________________________________________________ 
(2) Name             ____________________________________________________    Phone__________________
Address             ____________________________________________________________________________ 
Medical Information 
In the event of a medical emergancy, I authorize Tiny Treasures to seek emergency medical care for my child as deemed
necessary.
Signature          ________________________________________Date___________________
Unless you object, photos of your child may be posted on the school's Website.
Signature         ________________________________________Date___________________

Program(s) Requested (Please Check): 
Full Day    8:45-  3:30 
  Extended Half Day   8:45-12:30  
Full Day Kindergarten   8:45-  3:30 
Half Day   8:45-11:45
  Extended Half Day 11:45-  3:30
Half Day Kindergarten   8:45-12:30
Half Day 12:30-  3:30 
 
Half Day Kindergarten 11:45-  3:30   
   Before/After School Care $6.50 per child per hour
   Please Check Days Child Will Attend:      (Mon)          (Tue)          (Wed)          (Thur)          (Fri)


Please Read Carefully and Sign:
I wish to register my child for the school year. I understand thet tuition is a yearly fee that has been conveniently divided
into 10 monthly payment.
I agree to make payments promptly on the 1st of each month (1st payment due August 1st, 2nd payment due September 1st).
Signature:
                 ....................................................................................
 To reserve a space for your child, please include with your registration form the following non-refundable fees:
                                                                                      Registration Fee              =                   $ 50
                                                                                      1st Payment (june 2011) =  ____________         
                                                                                      Total Enclosed                =  ____________


You will not be considered registered without receipt of these payments.