2023-2024 Trinity Preschool Registration Form

Physical Address:
2411 Hwy 29 North
Danielsville Ga 30633

Mailing Address:
PO Box 365
Danielsville Ga 30633

Today's Date

Name

Date of Birth

Age as of Sept. 1st

Gender

Male Female

Will your child go to Kindergarten next fall?

Yes No

Mailing Address

Home Phone #

Parent/Guardian 1 Name (First & Last)

Parent/Guardian 1 Cell #

Parent/Guardian 1 Occupation

Parent/Guardian 1 Business #

Parent/Guardian 1 Email

Parent/Guardian 2 Name (First & Last)

Parent/Guardian 2 Cell #

Parent/Guardian 2 Occupation

Parent/Guardian 2 Business #

Parent/Guardian 2 Email

Siblings:

Attending Church:

Authorized To Pick Up Your Child:

Please list anyone other than you and/or your spouse.

Name

Phone #

Name

Phone #

Name

Phone #

Name

Phone #

Name

Phone #

Name

Phone #

Emergency Information

Child's Pediatrician

Pediatrician's Number

Person(s) authorized to act as parent(s) in an emergency:

Name

Address

Phone

Name

Address

Phone

Media Release Form

Trinity Preschool has my permission to take photographs and/or videos of my child, and to use those photos/videos for the purposes of promoting Trinity Preschool programs?

Select one:

Yes No

Health Information

By clicking the check box below, I agree to release all liability from Trinity Preschool & Trinity Baptist Church (members and volunteers) if my child is injured in any way during Preschool hours. I also grant permission to Trinity Preschool & Trinity Baptist Church personnel to seek emergency medical treatment for my child should it be needed. I understand that they will make every reasonable effort to contact me or another emergency contact that I provide.

Check Box

Is your child allergic to anything?

Yes No

If yes, please explain:

Does your child have any medical concerns we need to be aware of?

Yes No

If yes, please explain:

Do you have any concerns with the following?

Hearing Speech Vision None

Does your child have any other concerns we need to be aware of?

Yes No

If yes, please explain:

Notice of Exemption

I acknowledge that I have been informed that this program is 4 hours or less a day and is not required to be licensed by the Georgia Department of Early Care and Learning and this program is exempt from state licensure requirements, but is registered with Bright From The Start.

Covid-19 Risk And Waiver

Trinity Preschool Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

Trinity Preschool has put in place preventative measures as recommended by the Center’s For Disease Control and the Georgia Department of Public Health to reduce the spread of COVID-19; however, Trinity Preschool cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending ANY or ALL activities, events, and/or trips organized by Trinity Preschool, Danielsville, GA could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume all of the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending ANY or ALL activities, events, and/or trips organized by Trinity Preschool, Danielsville, GA and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at ANY or ALL activities, events, and/or trips organized by Trinity Preschool, Danielsville, GA may result from the actions of myself and others, including, but not limited to, Trinity Preschool employees, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at ANY or ALL activities, events and/or trips organized by Trinity Preschool, Danielsville, GA or participation in ANY or ALL activities, events, retreats, camps and/or trips organized by Trinity Preschool, Danielsville, GA programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Trinity Preschool or Trinity Baptist Church, Danielsville, GA, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions of Trinity Preschool, Danielsville, GA, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in ANY or ALL activities, events, and/or trips organized by Trinity Preschool, Danielsville, GA.

Electronic Signature

* If you are registering other siblings for Trinity Preschool, please submit separate forms for each child.

* The $150 non-refundable registration fee is required to paid within 7 days after you complete this form. (You do not have to pay if you are on the waiting list) You can mail a check to the address listed above or call me at 706-206-0263 to make arrangements.

*By submitting and signing this form, you agree to abide by all the Covid-19 Waiver, The Parental Policies and Procedures of Trinity Preschool and understand the notice of exemption.

* I certify that I am the parent or legal guardian of the above minor and confirm that the information I entered is accurate and true.
* I am at least 18 years old and I have read and agree to the terms of the above agreement.
* By typing my full name below, I am electronically certifying this waiver document just as if I would physically sign it if it was on paper.

Date:

Parent Signature:

2023-2024 Trinity Preschool Registration Form

Description

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