East Granby Congregational Church Nursery School
9 Rainbow Road
East Granby, CT 06026
2011-2012 Registration Form
Child's Name_______________________________ Birthdate__________________________
Parent/s Name/Occupation _____________________________________________________
Address_______________________________________ Phone________________________
Cell Phone___________________Email ________________________
__________Three year old class (Tues/Thurs) 9 AM to 11:30 AM ($1,530.00 for the year)
__________Four year old class (Mon/Wed/Fri) 9 AM to 11:30 AM ($1,998.00 for the year)
__________Four year old 5 Day ( Mon.-Fri.) 8:15 AM to 11:30 AM ($3,068.00 for the year)
I give permission for my family's name/address/email and phone numbers to be shared in the school directory.
Parent Signature _________________________
Current/Past siblings to attend EGCCNS
________________________________________________________________________________
How did you hear about our school ? _____________________________________
Emergency Information:
Please contact the following people in case we can't be notified.
The following people may pick up my child up from school:
I give my child permission to attend all field trips at East Granby Congregational Church Nursery School. I understand teachers will notify parents of each trip, and I may need to drive my child to the trips.
_____________Parent Initial ___________________Date
General Parent Responsibilities: filling out ALL forms for your child's file and hand in by AUG. 1st, 2011 and to pay tuition payments.
Registration is first come, first serve. Please consider your child registered for next year unless you are contacted by the school ASAP. Applications must be accompanied by a $50.00 ( non refundable) registration fee.
Parent Signature______________________________________ Date______________________
General Information for INCOMING students for general intake data. Information shared will not influence your admittance into our school
Group (educational )experiences your child has had :_______________________________________
Is/was your child ever receiving services such as speech, occupational therapy, physical therapy,etc. yes/no
If yes, please share (here or to the director) :___________________________________________________________
If no,please share any concerns you may have.
____________________________________________________________
Health issue and/or allergies :__________________________________________________
Date of last medical appt :______________________Medical forms filled out during a medical appointment are good for one year from appointment. Please attach current medical form or mail in after your next appointment.
