ST. AUGUSTINE & ST. MARY’S CATHEDRAL SCHOOL
SUNSHINE PRE-SCHOOL PROGRAM
Children ages 4 & 5 by Sept. 1
Monday-Wednesday-Friday AM Program: 8:15-11:00 AM ……….. $130.00 per month
OR
Monday-Wednesday-Friday PM Program: 12:00-2:45 PM…….… . $130.00 per month
Children ages 3 & 4 by Sept. 1
Tuesday-Thursday AM Program:…………….8:15-11:00 AM ……….$100.00 per month
OR
Tuesday-Thursday PM Program:…………….12:00-2:45 PM ………. $100.00 per month
(Sessions may be revised due to enrollment numbers.)
**Registration Fee - $35.00 (Non-refundable/Non-applicable toward monthly fees)
Tuition is due on the 10th of each month, September-May.
Name of Parent(s): _________________________ Address: _____________________
_____________________
Telephone: ___________________
Person(s) responsible for tuition (if different):__________________________________
Signature of Parent(s): __________________________________ Date_____________
Name of Child(ren) Male/Female Birthday 2 Day AM 2 Day PM 3 Day AM 3 Day PM
________________ ___________ _______ ________ ________ ________ ________
________________ ___________ _______ ________ ________ ________ ________
Date Registered: ____________________ Check #: _________________
Time: _____________________________ Amount: $_________________
ST. AUGUSTINE & ST. MARY’S CATHEDRAL SCHOOL
SUNSHINE PRE-SCHOOL PROGRAM
Student Information Form
2008-09
1. Child’s Name: ___________________________________________________
First Middle Last
2. Birthdate: ___________________ 3. Nickname: ________________
4. Date of Placement: __________ 5. Parish: ___________________
6. Parent(s)/Guardian(s) Names:
Mother _____________________________ Place of Employment________________________
Home Address_______________________ Work Telephone____________________________
City/State/Zip________________________
Home Telephone_____________________
Father _____________________________ Place of Employment _______________________
Home Address ______________________ Work Telephone ___________________________
City/State/Zip _______________________
Home Telephone ____________________
7. Parent can be reached when child is in preschool at:
_______________________________________________________________
Telephone Cell Phone
8. In case of illness, accident or emergency, the following physician, dentist may be called:
Medical – Name: ___________________ Telephone:_________________
Address: _________________
Dental – Name: ___________________ Telephone: ________________
Address: __________________
9. Source of Child’s regular medical & dental care: (if different from above)
Medical – Name: ___________________ Telephone:_________________
Address: _________________
Dental – Name: ____________________ Telephone: ________________
Address: ___________________
10. Two persons to be contacted if a parent cannot be reached in an emergency or when there is an injury requiring medical attention (These persons are also authorized to take the child from the preschool if needed)
1. Name ____________________________ 2. Name ______________________________
Address___________________________ Address ____________________________
Telephone _________________________ Telephone __________________________
Relationship ________________________ Relationship _________________________
11. Foods you do not want your child to have: __________________
12. Information on any special health problems your child has: _________________
________________________________________________________________
13. Child is right or left handed: _____________________________________
14. Written Authorization:
I/we hereby give permission for my child, _______________________, to be given ipecac
syrup in an emergency situation.
I/we hereby give permission to St. Augustine & St. Mary’s Cathedral Preschool to act in
an emergency situation for my child, _____________________, when I/we cannot be reached
or am delayed in arriving.
15. Other children in family:
Name ______________________ Birthdate _______________
Name_______________________ Birthdate _______________
Name ______________________ Birthdate _______________