Washington University Nursery School Enrollment Form
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Address
Street Address
Address Line 2
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Child's Class
First & Last Name
Address
Street Address
Address Line 2
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Employer Address
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First & Last Name
Home Address
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Employer Address
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First & Last Name
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First & Last Name
Emergency Contact Address
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Address
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First & Last Name
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First & Last Name
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Authorization for Emergency Medical Care

I understand I will be notified at once in case of my child's illness or accident, and I will make arrangements for medical care of my child with the physician or hospital of my choice. If I cannot be reached to make necessary arrangements or in a critical emergency requiring medical care, I hereby authorize Washington University Nursery School to contact my doctor.

First & Last Name
Hospital Address
Street Address
Address Line 2
City
State/Province
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First & Last Name
Acknowledgements:
A) The provider and I have agreed on a plan for continuing communication regarding my child's development, behavior, etc.
B) When my child is ill, it is understood and agreed that he/she may not be accepted at school.
C) I have been informed of this facility's policies pertaining to admission, care and discharge of children.
D) I have been informed that a copy of Licensing Rules for Child Day Care Homes/Licensing Rules for Child Care Center in Missouri is available at this facility for review.
E) I understand that, before the first day of attendance by my child, I will provide proof of completed age-appropriate immunizations or exemption from immunizations.
F) I have been notified that I may request notice at initial enrollment or anytime after whether there are children currently enrolled in or attending the facility for whom an immunization exemption has been filed.
G) I have been informed that the Nursery School will not be transporting my child.
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