What is your relationship to the child? *
Select… Mother Father Legal Guardian Other
Which program will your preschool child attend? *
Select… Two Day: Mondays & Wednesdays 9am-12pm Two Day: Tuesdays & Thursdays 9am-12pm Three Day: Mondays, Tuesdays, and Wednesdays 9am-12pm Four Day: Monday-Thursday 9am-12pm Other: for questions please email tdaun@myrwc.org
What is your preschool child's full name? *
Please include first, middle, and last name as it appears on their birth certificate
Is your preschool child's Mailing Address different from your Home Address? *
Select… Yes No
Preschool Child's Gender *
Select… Male Female
Preschool Child's Date of Birth *
Please include the month, day, and four digit year.
Does your preschool child have any allergies? *
Select… Yes No
Does your preschool child have any prescribed dietary requirements or needs? Does your student have any eating preferences or aversions that we should be aware of? *
Select… Yes No
Does your preschool child have any medical conditions that we should be aware of? *
Select… Yes No
Preschool child's Physician Information *
Please include physician's name, phone number, and address. MN State Licensing requires all preschool children to have a doctor on file, so if you do not have one yet, please establish care with a doctor prior to enrollment. For questions, email Tammy Daun, Preschool Director, at tdaun@myrwc.org
Preschool child's Dentist Information *
Please include dentist's name, phone number, and address. MN State Licensing requires all preschool children to have a dentist on file, so if you do not have one yet, please establish care with a dentist prior to enrollment. For questions, email Tammy Daun, Preschool Director, at tdaun@myrwc.org
Does your preschool child have any siblings?
We ask this so we can talk to our students about the members of their family as we get started in the school year. This information is an excellent springboard for learning more about one another.
Select… Yes No
Has your preschool child been in other group or school experiences?
Select… Yes No
Has your preschool child completed the early childhood screening offered by your local school district? *
If yes, do you have any questions, comments, or concerns regarding his/her assessment?
What elementary school will your preschool child eventually attend? *
If undecided, feel free to reply with that response.
Have there been any recent events that may impact your child's time at school?
Please explain any events that you feel will positively or negatively impact your child's time at school.
Is there any other information about your child or family that might be helpful for us to know?
Legal Guardians *
Please list the child's legal guardians.
Name of Emergency Contact #1 *
Please provide both first and last name. Ridgewood Preschool is required to obtain this information by MN State Licensing.
Phone Number of Emergency Contact #1
Ridgewood Preschool is required to obtain this information by MN State Licensing.
Home Address of Emergency Contact #1 *
Ridgewood Preschool is required to obtain this information by MN State Licensing.
Relationship to preschool child/family? *
Please tell us how you know Emergency Contact #1
Name of Emergency Contact #2 *
Please provide both first and last name. Ridgewood Preschool is required to obtain this information by MN State Licensing.
Phone Number of Emergency Contact #2 *
Ridgewood Preschool is required to obtain this information by MN State Licensing.
Home Address of Emergency Contact #2 *
Ridgewood Preschool is required to obtain this information by MN State Licensing.
Relationship to preschool child/family? *
Please tell us how you know Emergency Contact #2
Name of Emergency Contact #3 (optional)
Please provide both first and last name. Ridgewood Preschool is required to obtain this information by MN State Licensing.
Phone Number of Emergency Contact #3 (optional)
Ridgewood Preschool is required to obtain this information by MN State Licensing.
Home Address of Emergency Contact #3 (optional)
Ridgewood Preschool is required to obtain this information by MN State Licensing.
Relationship to preschool child/family? (optional)
Please tell us how you know Emergency Contact #3
I give permission to Ridgewood Preschool staff to obtain emergency medical treatment for my child should it become necessary. In the case of an emergency, I understand that my child may be transported by ambulance to a local hospital for treatment.
I understand that it is impossible to create a totally risk-free environment, and that Ridgewood Preschool cannot guarantee that any staff member or child will be safe from COVID-19 or any other transmittable diseases.
Media and Marketing *
I give permission for my child's picture (without name) to be placed in a Ridgewood Preschool or Ridgewood Church newsletter on their website, Facebook page, Instagram page, or in preschool marketing materials.
Select… Yes, I give my permission. No, I do not give my permission.
Activities and Equipment *
I grant permission to Ridgewood Preschool to allow my child to use all the school and playground equipment and participate in all activities of this preschool.
Select… Yes, I give my permission. No, I do not give my permission. Yes, I give my permission for certain activities and equipment...
I understand that parental permission will be obtained in writing before any occasion of research, assessment, or public relations activity involving children would take place at this preschool.
Cleaning and Sanitizing Procedures *
I authorize the use of baby wipes for hand clean-up after messy art projects, nonprescription sanitizing wipes, and/or instant hand sanitizer to be used in accordance with the manufacturers' instructions.
Select… Yes No Only certain products
Sunscreen and Insect Repellent *
I give permission for the Ridgewood Preschool staff to use the following products, as needed, on my child's exposed skin.
Contact Information Release *
I authorize Ridgewood Preschool to release my child's name, parents' names, and parents' phone numbers for the purpose of a class list that can then be used for getting together outside of school and possible carpooling needs.
Select… Yes, I give my authorization. No, I do not give my authorization.
If the staff at Ridgewood Preschool sends pictures, via text or e-mail, of the class, I know and agree that these photos are NOT to be posted onto any personal social media account(s).
Explanations and Details regarding "No" answers *
Please use this space to provide any additional information you'd like to share regarding any "no" response in the "Permissions, Releases, and Agreements" section. If this does not apply, please type N/A.
Date of Submission *
Please select today's date.
Submit
