LR Pre-School dba Lake Ronkonkoma Pre-School ST. LAWRENCE THE MARTYR CHURCH SCHOOL 200 W. MAIN STREET, SAYVILLE, NY TEL.

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1 REGISTRATION CHECKLIST Dear Mr./Mrs./Ms. Date We would like to welcome you and your child to the Lake Ronkonkoma Preschool. In order to have your child registered properly, we will require the following: Registration Fee $ June Tuition $ Registration Form Parent Contract / Health History Consent for Diaper Change / Change of Clothes Immunization Record Birth certificate (xerox copy) Picture Consent Form General Meeting Contract Student Release Form Registration forms can be found on our website at Kindly mail the completed forms to: L R P r e - S c h o o l Attn: 2 Year Old Registration 200 W. Main Street Sayville, NY Ext. 2 The Lake Ronkonkoma Pre-School has been renting classroom space in St. Lawrence the Martyr s School building since September, The pre-school is not, however, affiliated with either the parish, or the Catholic Diocese of Rockville Centre.

2 R E GISTRATION FORM Child s Name: M ( ) F ( ) Date of Birth: Parent s Name(s): Mother Father: Address: Town: Zip Code: Phone No.: address*: Cell Phone No.: * L R P S does not sell, rent, or otherwise release your address to any third party, nor do we use it for any purpose other than to you the school notices and reminders. Please place an X mark for your first (1 st ) and second (2 nd ) choice of session and days: Time / Schedule Days AM session 9:45 a.m. 11:45 a.m. PM session 12:30 2:30 p.m. AM session Mon, Wed ( 2A ) PM session Tue, Thu ( 2C ) AM 3-Day session Mon, Wed, Fri ( 2A ) AM session Tue, Thu ( 2B ) AM 3-Day session Tue, Thu, Fri ( 2B ) Please choose the time that is most convenient for you. (Teachers schedules will not be decided until late summer.) ** Tuition: 2 - D a y S e s s i o n $ p e r m o n t h 3 - D a y S e s s i o n $ p e r m o n t h How did you hear about the Lake Ronkonkoma Preschool? Kindly mail your completed Separation Class Registration Form to: L R P r e - S c h o o l 200 W. Main Street Sayville, Ny Ext. 2

3 PA R E N T C O N T R A C T PLEASE PRINT: Name of Child: (Last) (First) (Middle Initial) Date of Birth: Phone Number: Mother s Name: Father s Name: Address: PLEASE READ CAREFULLY BEFORE SIGNING I agree to prepay a tuition fee in the amount of $, plus a registration fee of $ payable at the time of enrollment. The tuition fee shall represent payment of tuition for the last month of school in June. Your regular monthly tuition in the amount of $ shall be due September 1, and due the first of each month thereafter for the months of October - May. Tuition received after the 15 th of the month is automatically subject to a $ fine. When tuition has become 2 months past due, your child can be subject to dismissal from the school. I agree that my child is entered for the entire school year and that I am obligated to pay tuition until written notice of withdrawal is presented to the Executive Board, 30 days prior to withdrawal. I understand that no refund of the registration will be made under any circumstance. I further understand that this is a cooperative pre-school and I agree to follow the regulations governing the school. *Tuition refunds will not be made after March 1. If for any reason you withdraw your child from school and a replacement cannot be found, June tuition will not be refunded. ** A copy of the Bylaws is available at the preschool. The Bylaws are also available on our web site at ** I agree to one mandatory fundraiser wherein my child will be required to sell $ worth of raffle tickets. In case of serious injury, if I cannot be contacted, the School has my permission to contact the local emergency services unit.

4 PLEASE PRINT AND FILL IN COMPLETELY: H E A L T H H I S T O R Y Child s Name: M ( ) F ( ) Date of Birth: Parent / Legal Guardian: Phone No.: OTHER THAN YOURSELF, Person (s) we can contact in case of emergency: Name: Phone No.: Name: Phone No.: Please check below if it is known to you that your child has any impairment as listed below: Vision Speech Hearing If yes, what has been done to correct the condition? Past illnesses: Check those the child has had and give approximate dates: Chicken Pox Asthma Measles German Measles Rheumatic Fever Hay Fever Diabetes Epilepsy Whooping Cough Scarlet Fever Mumps Other serious or severe illnesses or accidents? Does child have allergies? Yes No To what? Is your child taking any medication other than vitamins? Is there anything concerning the general health of your child that the school should know about? No. of Children in Household: Sibling/s Date/s of Birth:

5 CONSENT FOR DIAPER CHANGE / CHANGE OF CLOTHES Child s Name: * Please put an X next to what applies to your child: Potty Training Potty Trained Pull Ups Diaper Assistance / Wiping I authorize Lake Ronkonkoma Preschool to change my child s diaper / pull up / clothes when necessary. I agree to supply the preschool with an extra change of clothes, wipes, diapers and any other supplies needed. I prefer to change my own child and request that Lake Ronkonkoma Preschool call to notify me that my child needs to be changed. I agree to supply an extra change of clothes, wipes, diapers and any other supplies needed. P R O C E D U R E F O R A D M I N I S T E R I N G M E D I C AT I O N F O R C H I L D R E N W I T H L I F E T H R E AT E N I N G A L L E R G I E S The Staff of the Lake Ronkonkoma P reschool will not dispense any medication without a prescription and written instructions from a doctor, as well as written permission from the parent / legal guardian. This procedure is as per the insurance guidelines of the school s insurance policy. This policy is for the protection of your child and our staff. C h i l d s N a m e C l a s s

6 IMMUNIZATION RECORD or A COPY OF YOUR DOCTOR S RECORDS Child's Name: Date of Birth Address: Telephone No.: According to the N ew Yo r k Stat e P ublic H ealth Law, S ect ion 2 164, it is required that your child receives certain immunizations. Please have your physician complete and sign this form as proof of immunization. This must be returned to us within two weeks of registration. Thank you. DPT (list all dates) HIB (list all dates) Polio (list all dates) MMR HEP B (list all dates) Varivax or Varicella Please check if child is up-to-date on all immunizations Is there anything concerning the general health of this child that the school should know about? It is recommended that each child be given a complete physical examination prior to entering preschool and that his immunizations be brought up to date at this time. Before entering school, children are required to have proof of the following immunizations: DPT, Polio, Measles, Rubella, Mumps & HiB as required by the New York State Board of Health. P h y s i c i a n ' s S i g n a t u r e

7 P I C T U R E C O N S E N T & WA I V E R F O R M - Web Page Electronic Media Newspapers Brochures S t u d e n t N a m e C l a s s I hereby consent to having s picture appear in electronic media or print publications that Lake Ronkonkoma Preschool might choose to release. I understand that his / her picture may be on display in accordance with any of the above mentioned activities. I further acknowledge that my child s name may or may not be used in connection with his/her picture. I hereby agree on behalf of the above named student and with agreement of his/her parent or legal guardian to waive any claims against Lake Ronkonkoma Preschool which may arise from the use of any pictures used in accordance with a Lake Ronkonkoma Preschool publication. If at any time, I want my child s photograph to be removed from the Lake Ronkonkoma Preschool web site or other electronic media, I acknowledge that it is my responsibility to inform, in writing, the Executive Board of this decision.

8 G E N E R A L M E M B E R S H I P M E E T I N G Dear Parents, YOU ARE REQUIRED TO ATTEND EACH GENERAL MEMBERSHIP MEETING. EACH MEETING IS IMPORTANT TO YOU AND YOUR CHILD. By enrolling your child in the Lake Ronkonkoma Preschool, YOU ARE JOINING A COOPERATIVE PRESCHOOL. Attendance and punctuality is mandatory. These General Membership Meetings present an opportunity for you to learn about your child's curriculum. You are able to become informed about upcoming events. It is also an opportunity for you to meet your child's teacher and talk about your child's progress. At these meetings, you are able to get information about fundraisers and obtain general information about the school. It is a great chance to become involved in your child's school and meet other parents. The first general parent meeting will be held on September at 8:00 pm in the preschool. Please also note that there will be 4 additional mandatory meetings. All are Tuesday evenings and will start promptly at 8:00 pm in the preschool, so please make arrangements accordingly. Parents, please make childcare arrangements. As stressed above, these general membership meetings are extremely important. There will be a $10.00 fine if you do not attend a meeting or do not have a non-member represent you as outlined in our Bylaws. All members are required to put in writing any excuses for non-attendance prior to the meeting date and drop them off in the Chairperson's mailbox. ** A copy of the Bylaws is available at the preschool. The Bylaws are also available on our web site at w w w.l ak eronkon koma p res ch ool.com ** Thank you for your attention in this matter. Sincerely, The Executive Board I acknowledge and accept my obligations for the General Membership Meetings. Student's name: Class:

9 S C H O O L D O O R P O L I C Y Dear Parents, As per our school policy, the doors will be opened at 9 : 2 5 am for drop off and 11 : 55 am for pick up. For the 2 year olds, it will be opened at 9 : 4 0 am for drop off and 11:40 am for pick up. It is important that class starts on time, so please make every effort to arrive on time for your child's scheduled start time. The teachers only have a limited amount of time with the children, and every moment matters. Latecomers are to either ring the school's door bell or call the classroom telephone, and a staff member will open the door. Please be patient when ringing the bell or calling, the teachers are working with the children. We would appreciate cooperation with our procedure. If there are any questions, please feel free to contact our Chairperson. Thank you for your consideration in this matter. Sincerely, The Executive Board

10 Dear Parents, Attached you will find a STUDENT RELEASE FORM. Our teachers are diligent in checking the ID's on pick up time when they are not familiar with an individual. Please assist the teachers by informing them when there is a different person who will be picking up your child. At this time, we would like a written list of those individuals and if you know the particular days in which they will be coming, i.e. Wednesdays, please approach the teachers and let them know as soon as possible. If someone is coming to pick up your child and they are not on this list, the child will NOT be released to them. If there are any changes during the year, please notify the teachers and they will give you another form to fill out. Sincerely, The Executive Board

11 S T U D E N T R E L E A S E F O R M Student's Name: Class: Please list, OTHER THAN YOURSELF, individuals that you allow to pick up your child from school. As a courtesy, please let your child's teacher know ahead of time that someone other than yourself will be picking up your child. Please let this individual know that his / her ID will be requested at pick up time. 1. Name: Relationship: Contact Number/s: Pick up day/s: 2. Name: Relationship: Contact Number/s: Pick up day/s: 3. Name: Relationship: Contact Number/s: Pick up day/s: 4. Name: Relationship: Contact Number/s: Pick up day/s: 5. Name: Relationship: Contact Number/s: Pick up day/s: