Forest Preschool & Kindergarten Application

Student Information

Child's Name*

First Name

Last Name
Date of Birth

Guardian Information

Parent 1 Name*

First Name

Last Name

Parent 1 Home Address*

Address 1

Address 2

City

State

Zip/Postal Code

Country

Parent 1 Phone Number*

(###) ###-####

Parent 1 Email Address*

Parent 2 Name

First Name

Last Name

Parent 2 Home Address

Address 1

Address 2

City

State

Zip/Postal Code

Country

Parent 2 Phone Number

(###) ###-####

Parent 2 Email Address

Emergency Information

Child's Physician*

First Name

Last Name

Physician's Phone Number*

(###) ###-####

If either parent cannot be reached, please provide an emergency contact including name, relationship and phone number.*

Please list know medical conditions, allergies or dietary restrictions.

Explain any learning challenges or learning needs that your child has.

Explain any additional information you would like us to know about your child.

Enrollment

Days per week
I would like to enroll my child in the following class or classes for 2021-2022 school year. (check your choices)
2 days - Tuesday / Thursday3 days - Monday / Wednesday / Friday5 days - Monday - Friday

Morning or Afternoon
I would like to enroll my child in (check your choices):
Morning 9:00am - 12:00pmAfternoon 12:45pm - 3:45pm

What previous preschool/child care experience does your child have?
(This can also include any experience where they are away from primary caregivers)

How does your child handle separation? What are the strategies you use when/if separating is challenging for your child?

What are some of your child’s strengths?

What are some of your child’s challenges?

Why did you choose this program? What are you hoping your child can gain from this experience?

Waiver & Release

Liability Waiver*
Liability Waiver: I understand that South Mountain Nature School operates classes entirely outdoors and that there are risks which naturally occur whenever children are playing outside. I also understand that SMNS classes take place in a county park and that there are hazards over and underfoot that are beyond the control of Mary Clair Sonneman and South Mountain Nature School. I release Mary Clair Sonneman, South Mountain Nature School and it’s teachers and Board of Directors from any liability for injuries that might occur as a result of my child attending South Mountain Nature School. My child is in good physical health and I will provide appropriate clothing for the weather.
I have read, understand and accept the terms of the liability waiver.

Media Release*
Consent to Photograph: I do hereby consent and agree that South Mountain Nature School, LLC has the right to take photographs and video clips of my child and to use these on the Educator's websites and promotional materials without compensation. Your child's name and identity will not be revealed.
I have read, understand and accept the terms of the media contract.

Today's Date*

South Mountain Nature School Forest Preschool Allyship Grant Application (download application below)