Noah S Ark Preschool

Noah’s Ark Preschool 2018-2019

First Presbyterian Church Class______

Enrollment Form

Child’s (first, middle, last) ______

Gender Birth Date__

Home Address______Zip______

Home Phone______E-mail ______

Father’s Name______Mother’s Name______

Address (if different) ______

Employer______Employer______

Occupation ______Occupation ______

Work Phone______Work Phone______

Cell Phone______Cell Phone______

Family Status: Married / Separated / Divorced / Single / Widowed

EMERGENCY INFORMATION

In addition to yourself, who is authorized to remove your child from the premises?

Name______Phone______Relationship______

If a parent or guardian cannot be reached, who should be contacted in the event of an emergency? This person cannot remove the child from the premises unless listed above.

Name______Phone______Relationship______

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Allergies: Please list and describe

EMERGENCY MEDICAL INFORMATION

I, (we) the undersigned, parent(s) or legal guardian of ______, a minor, do hereby authorize/consent to medical treatment deemed necessary in the event of an emergency, accident or sudden illness and will assume any expense incurred by such care.

I, (we) are aware that Noah’s Ark Preschool will make every effort to provide medical treatment at the closest facility available. Noah’s Ark Preschool will make every effort to contact and work with the doctor and hospital of preference listed.

Doctor preferred______Phone______

Hospital preferred______Phone______

Medical Insurance Name______Policy #______

Medications______Allergies______

I, (we) do not hold the above named, or Noah’s Ark Preschool responsible or liable for any action necessary in the emergency care of my (our) child.

Signature______Date______

Relationship to child______

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VOLUNTEER DRIVER INFORMATION

Please Note: Noah’s Ark Preschool will not ask parents to transport a child from a different family (on field trips, etc.). However, the following is necessary for insurance.

The First Presbyterian Church’s policy and regulation regarding transportation to and from church/preschool sponsored activities requires that a volunteer driver shall have:

A valid Driver’s License.
Valid Auto Liability Insurance equal to or greater than the minimum State of Washington requirements ($25,000/50,000 Bodily Injury and $10,000 Property Damage Liability or $60,000 Combined Single Limit).
A well-maintained and safe automobile, with a seat for each passenger and operated in compliance with the State Seat Belt Law.

First Presbyterian Church’s liability insurance of $1,000,000 has been extended to provide excess liability coverage to a driver volunteer when they use their automobile on church business. This coverage is in excess of the limit stated above, which must be maintained by the volunteer.

First Presbyterian Church and Noah’s Ark Preschool thank you for your help in providing transportation to and from preschool sponsored activities. If you have any questions, please contact the Business Administrator at 694-3363. This is for all preschool field trips during the 2018-2019school year.

Signature______Date______

FIELD TRIP RELEASE

I/We hereby give permission for my/our child, ______, to participate in field trips arranged by Noah’s Ark Preschool personnel. This is for all field trips taken during the 2018-2019school year.

It is my understanding that all necessary precautions will be taken for the safety of the children on such trips. In case of an accident, I will not hold liable the church, instructors, other accompanying adults, or persons at the place of the destination.

Parent’s Signature ______Date ______

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CLASSROOM VOLUNTEER CONTRACT

I/We, ______, agree to serve as a preschool volunteer at Noah’s Ark Preschool.

I understand that as a volunteer I will:

Ask for and accept assistance from the teacher and aide.
Be open-minded and flexible.
Respect the confidentiality of all information concerning children.
Serve as a positive role model.

Never be alone with a student.

Signature:______Date:______

FAMILY BACKGROUND

Name and ages of brother(s) ______

Name and ages of sister(s) ______

Others living in the home______

Please list your own hobbies, skills, or training (musical, instrumental, art, dance, crafts, etc):

SOCIAL

What are the child’s favorite toys, activities and special friends:

Any unusual experience child has had (travel, new baby, etc):

Recent changes in child’s life (move, surgery, death in family, new baby, divorce, separation):

Are there any special days or holidays you do not want you or your child to participate in?

Your home church______

EMOTIONAL

Does anything frighten your child?

How do you handle the fear?

Methods of discipline used:

Child’s response to discipline:

How does your child show anxiety / frustration / anger?

Has child played with other children? Yes / No

Own age______younger______older______

How does child get along with other children?

Has child had any previous group experience?

If yes, please describe:

Does child exhibit any behavior that concerns you?

What do you expect your child to get out of the preschool experience?

DEVELOPMENTAL RECORD

Physical or health limitations of your child:

Was your child a preemie?

Describe any nervous habits:

Language: Is child easily understood?

Any speech difficulties? Explain:

Elimination:

What words does child use for toilet needs? Please note children must be toilettrained prior to the start of the school year. Please contact the director if you have any concerns.

Does child need assistance in toileting? (Note: Your child does need to be able to take care of his/her own toilet needs, if this is a concern, please discuss with the Director.)

Any other challenges, comments or information you would like to share?

Thank you for taking the time to fill out these forms. We look forward to a wonderful preschool experience for your child. Please do not hesitate to speak with your child’s teacher or the director if you have any concerns at any time.

MEDIA RELEASE

NOAH’S ARK PROGRAMS

A Ministry of First Presbyterian Church

4300 Main Street

Vancouver, WA 98663

360-694-3363

I give permission for my child, ______, to be photographed and/or videotaped during Noah’s Ark Preschool’s and/or First Presbyterian Church activities. My child’s image may appear in print or online promoting the school’s or church’s activities. I understand that my child’s name will not be used to identify my child. This permission form will be kept on file in the preschool office. If I would like to withdraw my permission, I may do so at any time.

Parent/Guardian:______(printed)

Parent/Guardian: ______(signature)

Date:______