Sleepy Tigers CILC Enrollment Form

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Name of Child 1

First NameLast Name

Child 1 Gender

Child 1 Birth Date

MonthDayYear

Child 1 preferred start date at Sleepy Tigers

MonthDayYear

Child 1 Enrollment Plan (please only select one)

Child 1 Enrollment Term

Child 1 Attendance Schedule: (3 days a week minimum. 3 days a week Needs to include a Monday or Friday)

Child 1 Tuition (please only select one)

Name of Child 2

First NameLast Name

Child 2 Gender

Child 2 Birthdate

MonthDayYear

Child 2 preferred start date at Sleepy Tigers

MonthDayYear

Schedule Request

Child 2 Enrollment Plan

Child 2 Enrollment Term

Child 2 Attendance Schedule: (3 days a week minimum. 3 days a week Needs to include a Monday or Friday)

Child 2 Tuition (please only select one for each child)

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

Comment:

General Information

My child is fully potty trained

Lunch Option (tuition includes school lunch)

Payment Schedule

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?

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 1: Name

First NameLast Name

Relationship

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

E-mail

Authorized Pick Up 2: 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

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:

Photo Release:

At Sleepy Tigers Chinese Immersion Learning Center, we often use photos of our students in school publications, flyers, advertisements, social media, 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:

Sunscreen / Cream / Wet Wipes / Bug Repellent Permission:

I give permission to Sleepy Tigers Chinese Immersion Preschool to apply sunscreen, cream, wet wipes, and/or bug repellent 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, wet wipes, or bug repellent and I will make every effort to apply sunscreen before my child arrives at school.

Sunscreen / Cream /Wet Wipes Permission:

*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.

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.

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.

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.

Health Care Summary

Upload a File

Immunization Record

Upload a File

Signature of Parent/Guardian

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

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Sleepy Tigers Chinese Immersion Learning Center

Acknowledgement

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