Sleepy Tigers CILC Enrollment Form

Sleepy Tigers Chinese Immersion Learning Center

Toddler, Preschool, Pre-K Enrollment Form
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Name of Child 1 *

First NameLast Name
Child 1 Gender*

MaleFemale
Child 1 Birth Date*

MonthDayYear
Child 1 preferred start date at Sleepy Tigers*

MonthDayYear
Name of Child 2

First NameLast Name
Child 2 Gender

MaleFemale
Child 2 Birthdate

MonthDayYear
Child 2 preferred start date at Sleepy Tigers

MonthDayYear
Home Language*
We celebrate (holidays):
Please share more about your child and your family:
Sibling 1

First NameLast Name
Birthdate

MonthDayYear
Sibling 2

First NameLast Name
Birthdate

MonthDayYear
Sibling 3

First NameLast Name
Birthdate

MonthDayYear
Schedule Request
Enrollment Plan*

Toddler Program (18 month to 33 month)Preschool / Pre-K (33 month to 6 years old, fully potty trained)
Attendance Schedule: (3 days a week minimum. 3 days a week Needs to include a Monday or Friday)*

MondayTuesdayWednesdayThursdayFriday
Tuition (please only select one for each child)*

Toddler 3 days a week $1621/monthToddler 4 days a week $1868/monthToddler 5 days a week $1998/monthPreschool / Pre-K 3 days a week $1361/monthPreschool / Pre-K 4 days a week $1582/monthPreschool / Pre-K 5 days a week $1698/month
Comment:
General Information
My child is fully potty trained*

YesNo. We will provide diapers, wet wipes and diaper cream
Lunch Option (tuition includes school lunch)*

School LunchI'll pack home lunch
Payment Schedule*

Once a month on the 1st of each month
Referral by a family form Sleepy Tigers. The Child's Name:
I have a coupon
Home Phone*

Area CodePhone Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Guardian 1’s Name*

First NameLast Name
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail*
Would you like to share your contact with other parents?*

YesNo
Employer
Guardian 2’s Name

First NameLast Name
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail
Employer
Persons Authorized to pick up your child (other than parents, you must provide two)
Authorized Pick Up: Name*

First NameLast Name
Relationship
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Name*

First NameLast Name
Relationship
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Emergency Contact Person (other than parents, you must provide two)
Emergency Contact: Same as Above

YesNo (please enter information below)
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Emergency: In case of an emergency or serious illness, when parents cannot be reached immediately, I hereby authorize Sleepy Tigers Chinese Immersion Learning Center to obtain emergency medical care and/or provide emergency medical transportation for my child.
Emergency:*
Transport: I hereby give the provider permission to transport my child in the vehicle provided by Sleepy Tigers on field trips, with written permission in advance.
Transport:

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Photo Release: Frequently we use photos of Sleepy Tigers Chinese Immersion Learning Center students in our school publications, flyers, advertisement and on our website. Unless you notify us at info@sleepytigers.com or 612-986-6010, photos of your child may be included in these publications.
Photo Release:

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Sunscreen / Cream Permission: I give Sleepy Tigers Chinese Immersion Preschool permission to administer sunscreen / cream to my child. I will provide sunscreen / cream with my child’s name written on the bottle. I will verbally notify the Teacher/Director when my child needs sunscreen / cream and will make every effort to apply sunscreen before my child arrives at school.
Sunscreen / Cream Permission:

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*This form must be completed by each family and must be reviewed annually by the parent/guardian, and any changes noted.
Primary Health Care Provider:*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If unavailable, another licensed Physician may treat my child.*

YesNo
Dentist:*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If unavailable, another licensed Dentist may treat my child.*

YesNo
Parent/Guardian Insurance Company:
Phone Number

Area CodePhone Number
Group #
List any allergies or health concerns:
Child 1*

First NameLast Name
Child 1 allergies or health concerns*
Child 2

First NameLast Name
Child 2 allergies or health concerns
AUTHORIZATION: We the undersign hereby agree by the arrangements and authorization to state above. We have discussed the information required in rule part 9502.0405.
Acknowledgement
- It is my/our desire to have my/our child/children enrolled in the toddler / preschool / pre-K program at Sleepy Tigers Chinese Immersion Learning Center. I/We have received/viewed the parent handbook. I/We also understand that my/our child is being accepted on a month trial basis. During this time, the staff will make observations and evaluations pertaining to the child’s ability to adapt to the school surroundings. Unless otherwise notified, the child/children will be accepted and permanently enrolled. I/We further understand that if the policies outlined in this handbook were not adhered to, it would be sufficient cause for the removal of the child/children from the program.
  
  I/We also agree to give a minimum of one month written notice of my/our intent to withdraw my/our child/children from the program. If one month notice is not given, I/we agree to make full tuition payment for the final month.
I/we understand that if my child is not fully potty trained, I/we need to provide diapers, wet wipes, and diaper cream for my child to use in school.
I/we understand that my child(ren) need to be fully potty trained in order to move to the preschool room.
I/we understand that my child(ren) must be immunized according to state law, unless a medical exemption applies.
I/we understand that I/we must provide a completed medical form to the school.
Health Care Summary

Upload a File

Cancelof
Immunization Record

Upload a File

Cancelof
I/we understand Winter, spring & summer breaks, holidays and absence will be charged at full tuition.
I/we understand payment is due on 1st of each month. Late fee or returned / denied payment fee due to insufficient fund is $25.
I/we understand the late pickup fee (after 5:30pm) is $1 per minute.
I/we understand a $10 fee will be charged for each time switching or changing attendance schedule.
I/we understand the illness policy.
I/we understand the behavior policy and I/we have read and shared the preschool rules with my/our child/children.
I/we have read and understand the photograph policy.
I/we have read and understand the field trip policy.
I/we understand Sleepy Tigers reserves the right to update and change tuition & policy with 60 days notice.
I/We understand there is 30 days advanced notice to withdraw from the program.
Signature of Parent/Guardian*

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Date*

MonthDayYear

Non-refundable registration fee $100 per child (please note we are unable to hold the spot until registration fee is received).*

Registration Fee$100.00

Quantity

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Sleepy Tigers Chinese Immersion Learning Center

Acknowledgement