Portland Nursery School Enrollment

Student Info:




Address:





Parent(s)/Guardian(s):






Emergency Info:


Please provide two additional contacts (relative, family friend, neighbor) that we can contact in case of emergency, if both parents cannot be reached.

Emergency Contact 1





Do you give permission to release the student from Portland Nursery School this person?
YesNo

Emergency Contact 2





Do you give permission to release the student from Portland Nursery School this person?
YesNo

Please identify the hospital of your choice for emergency treatment, if necessary.

We plan several field trips for the children each year. Please sign for your permission for your child to participate.
YesNo

Miscellaneous

Are you interested in scheduling a classroom visit?
YesNo

What hobbies, interests or talents would you be interested in sharing with your child’s classroom?

I am committed to being involved in the education of my preschooler. I understand that I will:
Work in the classroomChaperone and drive for some of the field tripsParticipate in fundraisingAttend monthly meetingsParticipate in the operation of the school through the elected Executive Board and Committees

An $85 non-refundable registration fee must accompany this form to reserve a space for your child. By signing this form, I agree to the monthly tuition payments of $195.00, which are due at the monthly parent meetings.