Application — Mindful Makers Preschool

Registration

Before completing registration, please read all of the information on the Tuition and Policies pages.
Please complete the entire registration. Submit this application along with $50 for enrollment.
Payments can be made through Venmo to @rachelcwalton
These fees are non-refundable.

Child's Full name

First Name

Last Name

Please let me know if there is an abbreviated version of your child's name that you would prefer she/he go by and learn how to write (e.g. Liv instead of Olivia)

Birthday

YYYY

Gender

Is your child Left or Right Handed?

Class Preference

I will do my best to honor class preference but cannot make any guarantees. Pre-K classes are reserved for students who will be entering Kindergarten the following year.

If preferred class is full...

Parent/Guardian Information (Required)

Primary Parent/Guardian Name

First Name

Last Name

Primary Parent/Guardian Home Address

Primary Parent/Guardian E-mail Address

Primary Parent/Guardian Phone Number

(###)

###

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Additional Parent/Guardian Information (Optional)

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Home Address

Parent/Guardian E-mail Address

Parent/Guardian Phone Number

(###)

###

####

Emergency Information

Emergency Contact #1

(Other than Parent/Guardian)

First Name

Last Name

Relationship to Child

Phone Number

(###)

###

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Emergency Contact #2

(Other than Parent/Guardian)

First Name

Last Name

Relationship to Child

Phone

(###)

###

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Child's Physician

First Name

Last Name

Physician's Phone Number

(###)

###

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Any Known Allergies

List of Acceptable People to Retrieve Child

I have read and agree to the policies explained on these pages (links found under the Register menu)

Tuition

Policies

Name

First Name

Last Name