General

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					General Health______________________________________________________________________


Limitations_________________________________________________________________________


Special Diet ________________________________________________________________________
            ATTACH SAMPLE MENUS OR SPECIAL DIET FOOD LIST TO THIS FORM.

Allergies___________________________________________________________________________


Medications used to treat Allergies.______________________________________________________


Yes, you may administer the following over the counter pain relievers__________________________


Doctor’s Name______________________________________________________________________

Doctor’s Phone _____________________________________________________________________

Doctor’s Address ____________________________________________________________________

           FEES/TUITIONS ARE NON-REFUNDABLE
Tuition is due in full the first Monday of each week. Full tuition is required to maintain the quality of our
staff through continuing education, low ratio, building maintenance, and supplies.

                            TUITION AND FEE POLICY
                                      K-6
Registration Fee ……………………………….......... $25.00 per session
Late Fee ………………………………………………$5.00 per minute after 6:00 P.M.
Late Fee on Payments after the first Wednesday of each week………$10.00 late fee
Return check…………………………………………………………$35.00 per item
Summer all day program …………………………………...............$135.00 per week
Summer camp one or more days a week …………………$40.00 per day

     Camp runs June 14 through August 20

                                   336-970-5102