Enrollment Form - St. James Preschool

Enrollment Information

Child's Name *

First, Middle, Last

Security access cards needed per family *

Parent/Guardian Information

Name *

Home Phone

Cell Phone

Home Address *

Country

City

State

Zip code

Employer

Work Phone

Work Address

Country

City

State

Zip code

Parent/Guardian Information

Name *

Home Phone

Cell Phone

Home Address *

Country

City

State

Zip code

Employer

Work Phone

Work Address

Country

City

State

Zip code

Communications

Family’s Primary Email Address *

Where you want to receive communication from St. James Preschool

Required Health Information

A Health Appraisal Form, signed by a Physician and Completed Immunization Records must be given to St. James Preschool Prior to your child attending preschool! Immunization records are provided by your physician.

Is your child current on all age appropriate vaccines in accordance with Colorado’s immunization requirements for school attendance? *

Yes

If no, what is the exemption you are claiming? *

Additional forms may be required for these exemptions.

Medical

Personal

Religious

Medical Information

Child's Doctor *

Phone *

Address *

Country

City

State

Zip code

Child's Dentist *

Phone *

Address *

Country

City

State

Zip code

Hospital of choice *

Swedish Hospital, 501 E. Hampden Ave. Englewood, 303 788-5000

Rose Medical Center, 4567 E. 9th Ave. Denver, 303 320-2121

Children’s Hospital, 1056 E. 19th Ave. Denver, 303 861-8888

Littleton Adventist Hospital, 7700 S. Broadway, Littleton, 303 730-8900

Porter Adventist Hospital, 2525 S. Downing, Denver, 303 778-1955

Sky Ridge Hospital, 10101 Ridgegate Pkwy, Lone Tree, 720 225-1000

Other

Name of Hospital *

Address *

Country

City

State

Zip code

Phone *

Health Insurance *

Group Number *

Address *

Country

City

State

Zip code

Phone *

Primary Carrier Name *

Primary Carrier Authorized Signature *

Reset Signature

Signature is required.

Compliance Agreement to Rules and Regulations

Please read, check each statement and electronically sign this agreement below.

I hereby agree to comply with the policies & procedures of St. James Preschool regarding fees, attendance, health/illness, parking, clothing, application of sunscreen and all other items specified in the Parent Handbook. *

I agree

I hereby agree to notify the school one month in advance of withdrawal, should such an event occur. *

I agree

I understand that tuition is an annual fee that may be paid in monthly installments. Tuition is due the first day of each month during the preschool year. The tuition will remain the same regardless of the number of days the child attends. *

I understand

I understand that I must provide my child’s health appraisal form, signed by a physician and current immunization records prior to my child attending preschool. *

I understand

IF immunization exemptions are claimed, I agree to provide additional forms required by the Colorado Department of Public Health and Environment.

Check only if this applies to you.

I agree

Signature *

Reset Signature

Signature is required.

Enrollment Information

Parent/Guardian Information

Parent/Guardian Information

Communications

Personal Information

Required Health Information

Medical Information

Permission From Parents For Medical Treatment, and Participation in Special Programs

Compliance Agreement to Rules and Regulations

St. James Preschool

3601 W. Belleview Ave.
Littleton, CO 80123

303-798-7844

hillary.newton@sjpreschool.org

Enrollment Information

Parent/Guardian Information

Parent/Guardian Information

Communications

Personal Information

Required Health Information

Medical Information

Permission From Parents For Medical Treatment, and Participation in Special Programs

Compliance Agreement to Rules and Regulations

St. James Preschool

3601 W. Belleview Ave. Littleton, CO 80123

303-798-7844

hillary.newton@sjpreschool.org

3601 W. Belleview Ave.
Littleton, CO 80123