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Application for Admission
Child's Name: _____________________________ Sex: ____________
Address: __________________________________
Zip Code: _____________
Phone Number: ______________________ Cell Phone #______________
Child's Date of Birth:
_________________
1.Father's Name: _______________________________________
Occupation: __________________________________________
Business Name: _______________________________________
Business Phone: ______________________________________
Business Address: ____________________________________
2.Mother's Name: _______________________________________
Occupation: __________________________________________
Business Name: _______________________________________
Business Phone: ______________________________________
Business Address: ____________________________________
3.Other Children in Family: Names & Ages _________________________________________________________
4.Primary
Language Spoken at Home: ________________________________________
5.Name & Phone Number of Family Doctor:
___________________________________
6.In Case of Emergency, whom do we contact? (other than parent)
Name:
_____________________ Phone Number: ___________
Relationship: ____________________
Name: _____________________
Phone Number: ___________
Relationship: ______________________
ALLERGIES____________________________
For Office Use Only:
Registration
Fee: ____________________
Tuition: ___________________________
Schedule: __________________________
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Parent Profile
The Highway Nursery School is a cooperative school. All parents are expected to serve on at least
one committee. It will be helpful, therefore, to know of your special training and interests. Listed below are the current
working committees.
· Hospitality: Responsible for refreshments at Parent Meetings, School Parties and Socials, acting
as Hostess etc.
· Fundraising: Every family is asked to be responsible to our fundraising activities during the year.
This committee primarily organizes the spring dinner.
· Lunch Bunch: This group of parents will help cover the lunch
hour between 11:15 and 12:15, on a once monthly basis, during which the faculty staff will meet.
Mother Full Name:
________________________________________________________
1. Do you have any interests and hobbies you would be willing
to share?
__________________________________________________________________
Father Full Name: _________________________________________________________
1. Do you have any interests or hobbies you would be willing to share?
_______________________________________________________
Committee Choice:
1. First Choice: ____________________
2. Second Choice: __________________
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Emergency Medical Treatment Permission Slip
A situation rarely arises where emergency treatment or hospitalization is necessary, but in such cases, prompt action
may be important. Be assured that at all times, we will use every effort to communicate with you rather than use this authority.
I hereby authorize the Highway Nursery School in case of emergency and when the parent or guardian cannot be contacted
to grant permission for my child __________________________ to receive medical and/or surgical emergency treatment while at
school and also to be admitted to a hospital and for the administration of an anesthetic and necessary operative procedure,
should an emergency arise.
It is agreed that any charges incurred will be at the expense of the parent or guardian and without liability on the part
of the Highway Nursery School, the Kings Highway United Methodist Church or their authorized representatives.
Signed _______________________________________ Date ___________________
Permission Slips
1. During the school year, I hereby allow my child ______________________, to play in the schoolyard.
Signed: ________________________________ Date: ________________
2. I also give my permission to allow my child to go on a neighborhood walk with his/her class.
Signed: _____________________________ Date: ___________________
3. I give permission to the Highway Nursery School personnel to remove my child's clothing so my child can be washed and
changed in the event that he/she has soiled him/herself. I understand that this will not be performed unless there are two
(2) school personnel present.
Signed: __________________________________ Date: _________________
4. I give permission to have my child photographed on the school premises for recreational and educational related activities.
I understand these pictures will never be used for advertisement purposes.
Signed: __________________________________ Date: ________________
I have read and understand the Highway Nursery School's Parent Handbook. I agree to abide by the rules and regulations
set forth by the Highway Nursery School in their entirety.
Parent Signature: __________________________________ Date: _________________
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