SEVENTH DISTRICT TOTS COOPERATIVE PRESCHOOL
APPLICATION FOR ADMISSION
2008-2009 School Year
Before completing this application, please be aware
that this program is a COOPERATIVE
program. Parents
are required to actively participate on a scheduled and nonscheduled basis,
over and above
any volunteered duties. Also, please read thoroughly all information you
receive
for a
complete understanding of how the program works and your important role.
Class Enrollment:
_____
3-year-old class Tuesday, Thursday 9am
– 11:30am
_____ 4-year-old class
Monday, Wednesday, Friday 9am-1:30pm
Child’s
name: _________________________Nickname ________________ Sex ___
Birth
date ___/___/___ Home
phone # ___________________ Email_____________________
Home
Address
________________________________________
________________________________________
Parents
or legal guardians________________________________________________________
(First and last names of both parents or
guardians)
Business
phone ____________________ __________________________________________
(Father’s)
(Father’s place of employment)
____________________ __________________________________________
(Mother’s) (Mother’s place of employment)
Child’s
physician
___________________________________ Office # ________________
Address
of physician
________________________________ Emergency #_____________
List
the names, addresses and phone numbers of three neighbors or close friends who
can be
contacted to pick up your child in the event of an
emergency (if you can’t be reached), or if you
are more than 15 minutes late picking up your
child.
Name Address Phone Number
______________________
_____________________________________ _______________
______________________
_____________________________________ _______________
______________________
_____________________________________ _______________
SEVENTH DISTRICT RECREATION & PARKS COUNCIL
Please
list any allergies your child has:
_______________________________________
______________________________________________________________________
Does
your child have any special traits, habits, or problems the instructor should
be aware of?
Please
explain:_______________________________________________________________
____________________________________________________________________________
List
the names of other children in the family. For each child give the child’s age
and whether
that child has attended this or any similar
program.
________________________________________________________________________________________________________________________________________________________
Are
you pregnant? _____ If yes, when is your due date? _____
(This information is needed for scheduling parent
helper days)
Does
your child have relatives or friends with an occupation, hobby or talent of
interest to the
children? For example: Policeman__, Letter
Carrier__, Nurse__, Dentist__, Beautician__,
Fireman__,
Doctor__, Clown__, Teacher__, Other___________________________________
Do
you have any special talents you could present for the children? For example:
music,
singing, storytelling, arts & crafts or tricks?
_________________________________________________
Would
you be willing to serve in any of the following areas?
Field
Trip Coordinator ____ Craft
Parent ____ Emergency Parent Helper____
Would you be willing to serve as Chairperson? _____
It
is necessary that you read and complete all information for the protection of
your child.
I
hereby approve of the terms of this registration form/contract. I further agree
that I will not
hold Department of
Recreation and Parks, 7th District Recreation Council, The Organizers,
Supervisors,
Sponsors, Volunteer Leaders or Participants responsible for injuries or any
unforeseen
accident while participating in the above named activity, or while traveling to
and
from
or being transported for this activity. I hereby state that I/my child am/is in
good health and
able
to participate in this program. I further acknowledge that I have read and
fully understand
the
above facts, as well as the parents’ code of ethics and the fact that the
Baltimore County of
Recreation
and Parks does not provide background checks on volunteers. I certify that all
answers,
to the best of my knowledge, are true and correct.
Enclosed
is my non-refundable check in the amount of $50.00 for the registration fee
made payable to: 7th District Recreation Council.
Parent Signature ________________________________________________ Date________