Preschool Program Enrollment Form - Ymca Buffalo Niagara (Page 4 of 4) in pdf

As the Y is for youth development, we would like to know why you chose the YMCA.

(Ex: I wanted my child

to improve his or her social skills. I wanted to help my child stay healthy by being more physically active. I wanted my

child to improve his or her academic performance.)

_______________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________

AgreeMeNt

•

Enrollment:

I consent to the enrollment of the child listed above in this facility and have been advised of the policies,

transportation, and the services provided by the facility and the New York State Department of Social Services regulations

under which it operates.

•

Field Trips and Transportation:

My child  is  is Not permitted to take part in field trips or excursions away from

the facility under proper supervision, including transportation provided by or arranged for by the UPK program.

•

Emergency Medical Care:

I agree that in the case of accident or injury, emergency medical care may be given in the event I

or the person(s) designated cannot be reached.

•

Correct Information provided:

I have provided special information on this registration to assist the facility in caring for

this child (diet, habits, allergies, medical issues, etc)

•

Parent Handbook:

I accept the policies and procedures contained in the Preschool Education parent handbook. I have read

and fully understand all policies and procedures contained within and agree to abide by them. I further understand that

failure to abide by the policies and procedures contained in this handbook could result in dismissal from the program.

Signature of Parent/person(s) legally responsible: __________________________________________________________________________ Date: _________________

offiCe use oNlY

____________________ ___________________

Program Director notified of allergies & medication

Date

Initials

____________________ ___________________

Form is complete (check boxes, allergy/medications)

Date

Initials

Preschool Enrollment Form 160310

YMCA BUFFALO NIAGARA Preschool Enrollment Form

Revised March 10, 2016 10:11 AM

Preschool Program Enrollment Form - Ymca Buffalo Niagara Page 4

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