Schedule a visit or call us today at (775)833-3801

​​​Little Explorers

Preschool & Childcare


Schedule a Visit or Call us Toda​y 775.833.3801

Copyright 2014. Little Explorers Preschool. All rights reserved.

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Child’s Information

Child’s Name________________________________ Name child goes by___________________________________

Age________  Birthdate_____________________  Sex ___________    Admission Date ______________________

 

Mother’s Name ___________________________________   Phone # (cell) ________________________________

Address ________________________________________                 (home) _______________________________

_______________________________________________               (work) _______________________________

Employer ____________________________________________   email address ____________________________

 

Father’s Name _____________________________________   Phone #  (cell) ______________________________

Address ___________________________________________                (home) ____________________________

___________________________________________________            (work) _____________________________

Employer ____________________________________________ email address _____________________________

 

List Additional People Authorized to Pick-Up Your Child

Name ______________________________________________ Phone # _________________________________

Address ______________________________________________________________________________________________________________________________________________________________________________________

Name ______________________________________________ Phone # _________________________________

Address ______________________________________________________________________________________________________________________________________________________________________________________

Name ______________________________________________ Phone # _________________________________

Address ______________________________________________________________________________________________________________________________________________________________________________________

 

 

Allergy Information

Allergy To: ______________________________________________________________________________________________________________________________________________________________________________________

Does your child require an Epi-Pen   [    ] yes (if yes, on must be kept at center)     [   ] no

Is your child asthmatic?  [    ] yes  [   ] no

Does your child require an inhaler or other medication?   [    ] yes (if yes, on must be kept at center)     [   ] no

 

Medication

Epinephrine: inject intramuscularly (circle one)                EpiPen                 EpiPen Jr.

Antihistamine: ___________________________________________________________________________________________

                                    Medication                                                           Amount

If ANY medication is needed you must fill out permission from.  If the medication is a prescription medication a note from your child’s doctor is also required before Little Explorers staff can administer medication.

 

Photography Information

I give permission for   Little Explorers Preschool and Childcare to use images of my child taken at school or school related events in any Little Explorers Preschool and Childcare publications and promotional materials.  These may include pictures in print materials, arts and crafts, presentations and on the Little Explorers Preschool and Childcare website.

I, ___________________________________________________ give Little Explorers Preschool and Childcare permission to take pictures of my child __________________________________________________ while in attendance at Little Explorers Preschool and Childcare

I do not grant Little Explorers Preschool and Childcare permission to take photos of my child, ___________________________________.

 

Field Trips

Field trips are an important part of education and will be taken periodically throughout the year.  Responsible adult supervision will always be provided on all excursions.   Little Explorers Preschool and Childcare will keep a teacher/child ratio of no more than 1:4 on all excursions.  Your permission for your child to participate is part of this agreement.  Notification will be given prior to all field trips.

I have read, understand and agree that may child will participate in outdoor explorations and excursions

Signature____________________________________________________________________________________

 

Attendance Schedule

Enrollment Date       ________________________________________

______ Monday    _________________ to __________________

______ Tuesday   _________________ to __________________

______ Wednesday    _________________ to __________________

______ Thursday    _________________ to __________________

______ Friday   _________________ to __________________

Your child start date is contingent on space available.  If space allows, your child will be enrolled as soon as required paper work and registration fee is submitted and accepted.

Immunizations

A copy of your child’s most recent immunizations will also be needed.  Your child must keep up to date on immunizations; failure to comply will result in termination.  Little Explorers respect each family’s religious beliefs.  If it is against your belief to have your child vaccinated, Little Explorers Preschool and Childcare will require a note from you stating so.

 

These forms along with registration fee must be completed and submitted to Little Explorers Preschool and Childcare before your child may attend. The Washoe County Physical Exam must be completed within the first 30 days of attendance.