Early Years Program

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Interested In *

2 Days Per Week (Tue. & Thu.)

3 Days Per Week (Mon., Wed., Fri.)

5 Days Per Week (Mon. - Fri.)

Does the child have any allergies? *

yes

no

Does the child have any medical, physical, developmental or emotional conditions? *

yes

no

Contact Name *

First Name

Last Name

Cell Phone *

(###)

###

####

Home Phone

(###)

###

####

Contact Name

First Name

Last Name

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

In case of an emergency, I give permission for my child to receive medical treatment.

Student Name *

First Name

Last Name

Student Name

First Name

Last Name

Student Name

First Name

Last Name

Name

First Name

Last Name

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Name

First Name

Last Name

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Are parents separated of divorced? *

Yes

No

If separated or divorced, is custody shared?

Yes

No

If custody is not shared, indicate custodial parent.

Mother

Father

Step-mother

Step-father

Grandparent

Guardian

Other

Main parent contact *

Mother

Father

Step-mother

Step-father

Grandparent

Guardian

Other

Occasionally, The Oxford School may photograph, videotape or record students participating in school activities. These recordings could be used in school publications, the school website, or in magazines or other print/broadcast media which may be distributed by the school to the public. The child’s name or other identifying information would not be published. *

I give permission for my child to participate.

I do not give permission for my child to participate.

For The Oxford School to best meet the needs of students it is necessary for the school to be fully aware of any identified learning disabilities or learning differences, use of an individual education plan, or past incidences or behaviour concerns. Failure to fully disclose any of the above could be grounds for The Oxford School to terminate the Enrollment Agreement.

I give permission for The Oxford School to contact my child’s last or current school.

A Student may be removed from roll at TOS should they not meet the standards of self regulation and discipline required for permanent admission to TOS. The tuition and registration fee is non-refundable. *

I acknowledge and agree to the terms as described above.

Parents Signature *

First Name

Last Name

Date *

MM

DD

YYYY