Preschool Prep Registration

Child's Name:
Date of Birth:

I hereby give permission to Play au Lait/Preschool Prep for my child's attendance in the enrichment program.

Drop off is at 9:00am and pick up is at 12:00pm noon.

Parent.Guardian Name:
Parent/Guardian Signature:
Parent Guardian Phone:
Parent/Guardian E-mail:

Emergency Contact Person's Name :
Emergency Contact Person's Phone:

In case I am not able to pick my child up, the following person(s) have permission to do so:

Alternate 1 Name:
Alt 1 Relationship:
Alt 1 Phone:
Alternate 2 Name:
Alt 2 Relationship:
Alt 2 Phone:

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