Dear Preschool Parent:

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1 Dear Preschool Parent: Thank you for choosing Monument Academy Preschool, Tri-Lakes premier Core Knowledge Pre-school. We are honored that you have chosen for us to help you in providing excellent care and foundational academic training. We do not take our responsibilities lightly and will do everything possible to ensure that your experience here is positive. Our preschool staff is dedicated, loving, and well-trained. They look forward to greeting your child each day and teaching them valuable skills they will need to be successful in school. Socially, emotionally, and academically we strive to implement our superior Core Knowledge program into every activity. We always welcome your presence and encourage you to come and watch us in action. Enclosed is a valuable packet of information as well as your registration forms. Once you have confirmed your decision on Monument Academy Preschool, we ask that you complete all of the required forms and secure all necessary documentation. You will turn your completed information into our front office. We cannot accept a partially completed packet and therefore ask that you complete everything before submitting it. After your packet is turned in and checked by our office staff, you may set up your payment options with our business office. You will be placed on our mailing and lists in order to receive updates throughout the summer. We look forward to being part of your child's preschool experience! Monument Academy Preschool Staff and Administration

2 Required Forms and Documentation Registration Form Home Language Survey Health Information Form Allergies Form (provided by MA upon request) Mandatory Permissions Form Preschool Handbook Signature Page/Letters of Agreement Authorization to Transport Physician Authorization to attend Preschool (Provided by Physician) Immunization Record Registered County Birth Certificate Copy of Parent Picture ID Preschool Tuition Contract Deposit Custody Documentation or Power of Attorney(if applicable) *Intent to Enroll Form will be copied for you to include in your packet. The office will need to keep a copy while you are completing the rest of your information. Information Entered into Infinite Campus: Date:

3 Registration Form Student Last: Student First: Student Middle: Start Date: Gender: Male Female Place of Birth: Ethnicity (Choose One) and Race (Choose one or more) Hispanic/Latino t Hispanic American Indian or Alaskan Native - A person having origins in any of the original peoples of rth, Central or South America. Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent. Black or African American - A person having origins in any of the black racial groups of Africa. Native Hawaiian or Pacific Islander - A person having origins in any of the peoples of Hawaii, Guam Samoa or Pacific Islands. White - A person having origins in any of the peoples of Europe, Middle East or rth America. Male Head of Household: Employer: Home Work Cell Legal Guardian? to Student: Reside With? Female Head of Household: Employer: Home Work Cell Legal Guardian? to Student: Reside With? Street Address: Mailing Address: (If Different) Address City State Zip Code Address City State Zip Code s of other children in the household (Please Include Preschool Students): Last : First : Middle: Last : First : Middle:

4 Registration Form (Continued) Emergency Contacts: List individuals that live locally, can be reached and are authorized to pick up your student Last : First : : Home Work Cell Last : Home First : Work Cell : Last : Home First : Work Cell : Has your child ever been in a Colorado School? Has your child ever been enrolled in this district before? Has your child ever been assigned to any Special Programs? If yes, please specify: Last School Attended: Address City State Zip Code Country If neither guardian nor emergency contacts are available, I authorize school personnel to use their best discretion in caring for my student. Date/Time For school use only: School Assignment: Contact/ Transportation: Copies To: Parent/Guardian School SPED (IEP) Accounts Payable (Pre-K / K) Information Entered By:

5 Home Language Survey Student Last: Student First: Parent/Guardian : Student Middle: What Language(s) did your child use when he/she began to speak? What languages are spoken to the child by the following people? Mother Father Siblings Others in the Home Do the adults in your home (parents, guardians, grandparents, others) speak to each other in a language other than English all or part of the time? If, what language(s) are spoken/how often? Child's Country of Birth: Date Child Entered Colorado Can information be send home in English? Date Child Entered USA If a language other than English has been indicated above, your child's English proficiency may be tested. Does your child understand the conversations between adults in the home when they are speaking a language other than English? Does your child participate in the conversation even though he/she might use English? What Language(s) did your child read? What Language(s) did your child write? Did your child ever attend school in another country? If yes, in which country and during what grades? What languages where used for instruction? Parent or Guardian Signature Date/Time

6 Health Information Form This information will help us provide the best services for your child Student Legal : Male Head of Household: to Student: Home Work Cell Female Head of Household: to Student: Home Work Cell Physician's Physician's Address City State Zip Code Preferred Hospital Dentist's Dentist's Address City State Zip Code Check conditions listed below if student currently has any of the following: ADD Autism Developmental Delays Orthopaedic Problems ADHD Congenital Defects Head Injuries Prematurity Allergies Depression Heart Condition Seizures / Epilepsy ** Student Has EpiPen Asthma ** Student Has Inhaler Asperger's Diabetes - Type I ** Pen / Injections ** Pump Diabetes - Type II High Blood Pressure Migranes Mood Disorder Neurological Disorder Types of Seizures Other If you checked any above, please explain: Is your child under medical care for any of above health concerns? Please Explain:

7 Health Information Form (Continued) Does your student take medication regularly? Medication: Dosage Times a day: Taken for: Has the student had any immunizations within the last year? Has the student had any serious injuries, illnesses or surgeries? Please attach record copy to form Are there any physical conditions limiting the students activity? Does student wear any prosthetic devices? (hearing aides, crutches, artificial limbs, braces) Does the student wear glasses? Does the student wear contact lenses? Does the student have a known color deficiency? Optometrist : Does the student have any hearing, speech or language difficulties? Date of last eye exam Date of last physical exam Date of last dental exam Does the student have any special dietary limitations? Any other health, emotional or legal concerns about the student? Does your student have an IEP, 504 or school action plan? Is the student covered by a health insurance plan or Medicaid? of Carrier: Previously reported condition which is now no longer a problem? Is there anything about your child we need to know? I give permission for this information to be shared with adults in the school setting who will be working with my child on a need to know basis. It is the responsibility of the parent to notify the school nurse whenever there is a change in the student health status or care. Date/Time

8 Mandatory Permissions Form Please list all children that attend Monument Academy from youngest to oldest: Last : First : Middle: Last : First : Middle: Last : First : Middle: Contact Information Release:, I give permission to release my student's phone number to other Monument Academy families ONLY!, I do not grant permission to release my student's phone number to anyone. Photograph Release:, I give permission to release my student's photo / name for promotional purposes., I do not give permission to use my student's photo / name. This includes photos in the MA school yearbook, class s & slideshows Art Project / Work Release:, I give permission to display my student's work., I do not give permission to display my student's work. This includes work on bulletin boards and displays within MA Carpool Sign-Up:, I am interested in being on the carpool list for Monument Academy. I have filled out the information below to be included. I would like to be contacted (phone) at: I am not interested in being on the carpool list. Woodmoor rth Black Forest Palmer Lake Woodmoor South Fox Run Larkspur Jackson Creek Kings Deer Colorado Springs (Zip: ) Glen Eagle Monument Other: Date/Time

9 Preschool Parent Letter of Ageements (initial) We have read, understand, and are committed to abide by the policies and procedures as outlined in the Monument Academy Parent/Student Handbook (specifically but not limited to the section regarding the preschool). (initial) We confirm that the preschool child being registered is potty trained according to the guidelines as outlined in the Monument Academy Student Handbook. (initial) We understand that Monument Academy Preschool follows the same basic calendar schedule as grades K-8 in regard to non-contact days including but not limited to holidays, an allotment of snow days and conference days. As such, these days have been taken into consideration with regard to the annual tuition and no tuitions will be refunded for delay start days, snow days or student absences. Parent Printed : Date: Parent Printed : Date:

10 Authorization to Transport Student : The following persons ARE authorized to transport my child to and from Monument Academy Preschool: The following persons are NOT authorized to transport my child to and from Monument Academy Preschool: I authorize Monument Academy preschool staff to sign my child in and out of class for the express purpose of participating in car line during the 2015/16 school year. Parent Printed : Cell Phone Date: Daytime Phone Preschool Staff will be notified of any changes. I.D. will be required for any unfamiliar persons

11 Dear Parent/Guardian, Preschool Tuition Contract Congratulations! Your child has been accepted to the Preschool program at Monument Academy. We are delighted you and your family will be joining Monument Charter Academy. From the options below, please let us know what schedule you would like for your child: Level One Options Must be 2.5 years of age prior to first day of school M/W AM (8:00am - 11:00am) & FRI. (8:00am-12:00pm) 10 payments of $ M-TH AM (8:00am - 11:00am) & FRI. (8:00am-12:00pm) 10 payments of $ T-TH AM (8:00am - 11:00am) 10 payments of $ T-TH PM (11:45am - 2:45pm) 10 payments of $ Level Two Options Must be 3.5 years of age prior to first day of school M/W/F AM (8:00am - 12:00pm) 10 payments of $ M-TH PM (11:45am - 2:45pm) 10 payments of $ M-F Dual (M-Th 8:00am - 2:45pm and Fri. 8:00am - 12:00pm) 10 payments of $ T-TH All Day (8:05am - 2:45pm) 10 payments of $ T-TH Dual (8:00am - 2:45pm) 10 payments of $ The first payment plus a $35 materials fee is due at this time. This is a non-refundable deposit that ensures your child's seat in the program. The remaining payments are due the first day of each month from August to April. Please sign the bottom of this form and return it with your non-refundable deposit. Make checks payable to Monument Academy. Call Julie Shook at , extension 1248, if you are interested in paying by credit card, PayPal or automatic check withdrawal. Monthly tuition statements will not be mailed but will be posted on your Infinite Campus Parent Portal. Please visit for information on how to sign up for a Parent Portal. Late Fees: If payment has not been received by the 10th of the month a $10 late fee will be added to the balance due. If no arrangement for payment has been made and payment is 30 days past due, the Principal will be notified and your child may be removed from the Preschool program. By signing this acceptance letter you agree to make payment(s) when due and to abide by the policies and regulations of Monument Academy. Student : Parent Printed : Date: Mailing Address: Address City State Zip Code Daytime Phone

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