Summer Registration form new student. First School Detailed Registration 2024-2025 Please complete the form below and submit. First School 2024-2025 Choose your Days (June 3-June 27)Monday/WednesdayTuesday/ThursdayMonday - Thursday (if available)First Available First School 2024-2025 Choose your Days (July 8-Aug 1)Monday/WednesdayTuesday/ThursdayMonday - Thursday (if available)First Available Choose your Pick-up Time8:00am - noon8:00am - 2:30pm How old will your child be as of August 1, 2024? Choose your child's age group12-20 months21-28 months29-35 months3-year-old4-year-oldKindergarten Name Child goes by Current Age Date of Birth Child's full name Child's full name First First Last Last Gender M F Name and age of sibling(s) Child's primary residence is with Mother Father Both Parents Guardian Parents are Married Divorced Separated Single If Divorced, who has custody? Mother Father Both Guardian Mother's name Mother's name First First Last Last Cell phone Address Employer Phone Work Hours Email Home phone Father's name Father's name First First Last Last Cell Phone Address Employer Phone Work Hours Email Home phone Emergency Contact Information Please provide the following information for an emergency contact person if the parent cannot be reached. Below please include all others who can pick up your child. We cannot release a child to anyone without this consent. Any person picking up a child who is unknown to the First School staff is required to show a picture ID. Name Name First First Last Last Relationship to the child Home phone Work phone Should be called in an emergency Yes No Name Name First First Last Last Relationship to the child Home phone Work phone Should be called in an emergency Yes No All others who may pick up your child. (Ask them to bring their ID.) Name Name First First Last Last Relationship to the child Phone Name Name First First Last Last Relationship to the child Phone Name Name First First Last Last Relationship to the child Phone Medical Information Please fill out the information completely. Child's name Child's name First First Last Last Physician's name Clinic Address Phone Please list any allergies (including food, seasonal, chemical, animal, etc.) that your child has been diagnosed with: Please list any nutritional or special dietary needs: Any disease history? Measles Mumps Chicken Pox Whooping Cough Hep A/B/C Please list dates of diagnosis on all that apply: None Cancer diagnosis Hemophilia Leukemia Diabetes Epilepsy Heart Defect HIV/AIDS Tuberculosis Hypoglycemia Please check all that apply ADD/ADHD Bed wetting Biting Fainting spells Frequent colds Frequent ear infections Febrile fever seizures Seizures Sun sensitivity None Other If Other, please describe. Physical, emotional or developmental concerns about your child: Emergency Medical/First Aid Consent I authorize First School, or its duly appointed representative, to seek emergency medical care for my child. Such care may include transportation to and from the hospital, medical care from a licensed physician if a parent/guardian cannot be reached, as well as first aid treatment by First School staff. While it is understood that reasonable precautions will be taken by the First School staff to prevent accident or injury to my child while in their care, I will not hold them legally responsible for such accident or injury. Child name Child name First First Last Last Parent/Guardian name Parent/Guardian name First First Last Last Date How did you hear about First School? If you are human, leave this field blank. Submit
