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 36 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 the event of an emergency or serious illness when I cannot be reached immediately, I hereby authorize Sleepy Tigers Chinese Immersion Learning Center to obtain emergency medical care and/or arrange emergency medical transportation for my child.
Emergency:*
Transport:

I hereby give Sleepy Tigers Chinese Immersion Learning Center permission to transport my child in a vehicle provided by the center for field trips, with prior written permission obtained for each trip.
Transport: *

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Photo Release:

At Sleepy Tigers Chinese Immersion Learning Center, we occasionally use photos of our students in school publications, flyers, advertisements, and on our website.

If you do not wish for your child’s photo to be used, please notify us by email at info@sleepytigers.com or by phone at 612-986-6010.

Unless we receive notification, your child’s photo may be included in these materials.
Photo Release:

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Sunscreen / Cream / Wet Wipes Permission:

I give permission to Sleepy Tigers Chinese Immersion Preschool to apply sunscreen, cream, and/or wet wipes to my child as needed. I will provide these items clearly labeled with my child’s name.

I will verbally inform the Teacher or Director when my child needs sunscreen, cream, or wet wipes, and I will make every effort to apply sunscreen before my child arrives at school.
Sunscreen / Cream /Wet Wipes 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

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Sleepy Tigers Chinese Immersion Learning Center

Acknowledgement