Family Registration

To register your family with The Premier School, you must complete the electronic form below or print and complete the PDF here.






    Parent/Guardian Information

    Mother/Guardian

    First Name
    M.I.
    Last Name
    Address
    Occupation
    Employed By
    Work Address
    Work Hours
    Home Phone
    Office Phone
    Cell Phone
     
    Custodial Parent
    Driver’s License #
    Email
     
    Preferred PIN number for checking in/out (4 digits, numbers only)
    1st Choice
    2nd Choice
    Marital Status
    MarriedSingleDivorcedSeparatedWidowedOther:

     

    Father/Guardian

    First Name
    M.I.
    Last Name
    Address
    Occupation
    Employed By
    Work Address
    Work Hours
    Home Phone
    Office Phone
    Cell Phone
     
    Custodial Parent
    Driver’s License #
    Email
     
    Preferred PIN number for checking in/out (4 digits, numbers only)
    1st Choice
    2nd Choice
    Marital Status
    MarriedSingleDivorcedSeparatedWidowedOther:

     

    Child Information

    First Child

    First Name
    M.I.
    Last Name
    Name child prefers to be called
    Grade/Class
    Gender
    Date of Birth
    Child’s Address
    List any existing medical conditions, medication and/or special attention your child may require?
    Allergies
    Pediatrician’s Name
    Pediatrician’s Phone
    Pediatrician’s Address
     
    Has your child been enrolled in another licensed child care facility in the past 3 months?
    YesNo
    If yes, then whom were you previously enrolled?
    Photographs: May we take and maintain photos of your child for Parent Website Portal?
    YesNo

    Second Child

    First Name
    M.I.
    Last Name
    Name child prefers to be called
    Grade/Class
    Gender
    Date of Birth
    Child’s Address
    List any existing medical conditions, medication and/or special attention your child may require?
    Allergies
    Pediatrician’s Name
    Pediatrician’s Phone
    Pediatrician’s Address
     
    Has your child been enrolled in another licensed child care facility in the past 3 months?
    YesNo
    If yes, then whom were you previously enrolled?
    Photographs: May we take and maintain photos of your child for Parent Website Portal?
    YesNo

    Third Child

    First Name
    M.I.
    Last Name
    Name child prefers to be called
    Grade/Class
    Gender
    Date of Birth
    Child’s Address
    List any existing medical conditions, medication and/or special attention your child may require?
    Allergies
    Pediatrician’s Name
    Pediatrician’s Phone
    Pediatrician’s Address
     
    Has your child been enrolled in another licensed child care facility in the past 3 months?
    YesNo
    If yes, then whom were you previously enrolled?
    Photographs: May we take and maintain photos of your child for Parent Website Portal?
    YesNo

    Fourth Child

    First Name
    M.I.
    Last Name
    Name child prefers to be called
    Grade/Class
    Gender
    Date of Birth
    Child’s Address
    List any existing medical conditions, medication and/or special attention your child may require?
    Allergies
    Pediatrician’s Name
    Pediatrician’s Phone
    Pediatrician’s Address
     
    Has your child been enrolled in another licensed child care facility in the past 3 months?
    YesNo
    If yes, then whom were you previously enrolled?
    Photographs: May we take and maintain photos of your child for Parent Website Portal?
    YesNo

     

    Emergency Contacts & Authorized Pickup Persons

    1st Contact/Pick Up

    Name
    Phone
    Relationship to the Child
    PIN for check in/out
    (numbers only)
     
    Able to pick up all children in the familyNot able to pick up the following children:

    2nd Contact/Pick Up

    Name
    Phone
    Relationship to the Child
    PIN for check in/out
    (numbers only)
     
    Able to pick up all children in the familyNot able to pick up the following children:

    3rd Contact/Pick Up

    Name
    Phone
    Relationship to the Child
    PIN for check in/out
    (numbers only)
     
    Able to pick up all children in the familyNot able to pick up the following children:

    4th Contact/Pick Up

    Name
    Phone
    Relationship to the Child
    PIN for check in/out
    (numbers only)
     
    Able to pick up all children in the familyNot able to pick up the following children:

     

    Tuition / Payment Information

    Current Tuition Amount
     
    WeeklyBi-WeeklyMonthlyOther:
    Please outline below whom is responsible for payment of tuition and fees. Please fill out if parents are divorced and split tuition payment or if tuition payment is the responsibility of an adult other than the parents listed above.

     

    Additional Comments & Information

    Is there is any other information that that would be helpful to our management and teaching staff?

     

    I agree that all information in this form is accurate.
     

     

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