Register for our Preschool

Child's Full Name *

Child's Date of Birth *

Child's Gender *

Male

Female

Child 1 T-Shirt Size

Child XS

Child S

Child M

Child L

In addition to those listed above, the following individuals may pickup my child:

Authorized Adult 1 Full Name *

Authorized Adult 1 Phone *

Authorized Adult 2 Full Name

Authorized Adult 2 Phone

Authorized Adult 3 Full Name

Authorized Adult 3 Phone

Does Q&A Preschools have authorization to obtain emergency medical care?

Yes

No

Does Q&A Preschools have authorization to transport emergency medical treatment?

Yes

No

To keep our preschool running smoothly, please agree to all of these policies:

I agree to abide by the Policies & Procedures Handbook which I will receive.

Parent Agreement *

I agree to all of the policies listed on this form.

I give permission to Q&A Preschools to photograph my scholar for uses of program promotion via social media, website, or print. *

I agree

I do not agree

I agree that this Waiver and Release of Liability shall apply to each day I am at Q&A Preschools regardless of the date that this form is signed below. I agree I will assume the risk and full responsibility for any and all injuries, losses, or damages, that might occur to my child or other family members while on the premises of the preschool or participating in any off-site preschool program or activity; and to the maximum extent of the law, I agree to waive and release any and all claims, suits or related causes of action against Q&A Preschools, their owners, officers, employees or agents for injury, loss, death, costs or other damages to me, my heirs or assigns, or third parties for claims, suits or related causes of action asserted against the preschool arising from my conduct and/or my family’s conduct while participating in the preschool’s programs or activities. I further agree to release, indemnify, defend and hold Q&A Preschools harmless from any liability whatsoever for future claims presented by my child for any injuries, losses or damages. I agree that this Waiver and Release of Liability shall apply to each day I am at Q&A Preschools regardless of the date that this form is signed below. I agree I will assume the risk and full responsibility for any and all injuries, losses, or damages, that might occur to my child or other family members while on the premises of the preschool or participating in any off-site preschool program or activity; and to the maximum extent of the law, I agree to waive and release any and all claims, suits or related causes of action against Q&A Preschools, their owners, officers, employees or agents for injury, loss, death, costs or other damages to me, my heirs or assigns, or third parties for claims, suits or related causes of action asserted against the preschool arising from my conduct and/or my family’s conduct while participating in the preschool’s programs or activities. I further agree to release, indemnify, defend and hold Q&A Preschools harmless from any liability whatsoever for future claims presented by my child for any injuries, losses or damages.

I agree to pay the monthly tuition by the first class of each month, as well as the non-refundable registration fee to reserve my child’s place and pay for his/her school supplies. *

Clear

Date Signed

Please Complete the Form to Register Your Scholar