Sleepy Tigers CILC 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

Preschool / Pre-K Schedule Request

Enrollment Plan*

Full Year (Jan-Dec)School Year (Sept-June. Resubmit enrollment form each year and your child will be placed on the waitlist for the next available spot.)

Attendance Schedule: (3 days minimum)*

Tuition (please only select one)*

5 days a week $1360/month4 days a week $1264/month3 days a week $1077/month

Comment:

General Information

Lunch Option*

Home LunchSchool Lunch $6.00/meal

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*

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:

Clear

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:

Clear

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:

Clear

*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.

It is my/our desire to have my/our child/children enrolled in the 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 I/we must provide a completed medical form to the school.

Health Care Summary

Immunization Record

*

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 vacation policy.

*

I/we understand that I/we can change lunch option on a monthly basis, I/we need to notify school before the 20th of each month for the following month lunch option change.

*

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*

Clear

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

Sleepy Tigers Chinese Immersion Learning Center

Acknowledgement