Sleepy Tigers CILC Summer School

Sleepy Tigers Chinese Immersion Learning Center School Age Care Enrollment Form

(Registration fee is not required during 2020-2021 school year)
Please fill out one form for up to two chuldren each family. This form works best using Google Chrome, Safari or FireFox.
Name of Child 1 *

First Name Last Name
Child 1 Gender *

Male Female
Child 1 Birth Date *

Month Day Year
Grade in Upcoming School Year *
Name of Child 2

First Name Last Name
Child 2 Gender

Male Female
Child 2 Birth Date

Month Day Year
Grade in Upcoming School Year
Home Language *

Mandarin Cantonese English Spanish French German Arabic Russian Other Language
We celebrate (holidays):
Sibling 1

First Name Last Name
Birthdate

Month Day Year
Sibling 2

First Name Last Name
Birthdate

Month Day Year
Sibling 3

First Name Last Name
Birthdate

Month Day Year
School Age Care Schedule Request
Monday Tuesday Wednesday Thursday Friday
Comment:
General Information
Lunch Option *

Home Lunch
Payment Schedule *

Once a month on the 1st of each month
Tuition: *

School Age K-5, $50/day (with minimum age requirement of currently in Kindergarten, entering 1st grade in the upcoming fall)
Referral by a family form Sleepy Tigers. The Child's Name:
I have a coupon
Home Phone *

Area Code Phone Number
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Guardian 1’s Name *

First Name Last Name
Cell Phone *

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail *
example@example.com
Employer
Guardian 2’s Name

First Name Last Name
Cell Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail
example@example.com
Employer
Persons Authorized to pick up your child (other than parents, you must provide two)
Authorized Pick Up: Name *

First Name Last Name
Relationship
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Name *

First Name Last Name
Relationship
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Emergency Contact Person (other than parents, you must provide two)
Emergency Contact: Same as Above

Yes No (please enter information below)
Name

First Name Last Name
Relationship
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Name

First Name Last Name
Relationship
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Emergency: In case of an emergency or serious illness, when parents cannot be reached immediately, I hereby authorize Sleepy Tigers Chinese Immersion Learning Center to obtain emergency medical care and/or provide emergency medical transportation for my child.
Emergency: *

Clear
Transport: I hereby give the provider permission to transport my child in the vehicle provided by Sleepy Tigers on field trips, with written permission in advance.
Transport:

Clear
Photo Release: Frequently we use photos of Sleepy Tigers Chinese Immersion Learning Center students in our school publications, flyers, advertisement and on our website. Unless you notify us at info@sleepytigers.com or 612-568-8819, photos of your child may be included in these publications.
Photo Release:

Clear
*This form must be completed for up to two children enrolled and must be reviewed annually by the parent/guardian, and any changes noted.
Primary Health Care Provider: *
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
If unavailable, another licensed Physician may treat my child.

Yes No
Dentist: *
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
If unavailable, another licensed Dentist may treat my child. *

Yes No
Parent/Guardian Insurance Company:
Phone Number

Area Code Phone Number
Group #
List any allergies or health concerns: *
AUTHORIZATION: We the undersign hereby agree by the arrangements and authorization to state above. We have discussed the information required in rule part 9502.0405.
Acknowledgement
- It is my/our desire to have my/our child/children enrolled in the preschool / pre-K program at Sleepy Tigers Chinese Immersion Learning Center. I/We have received/viewed the parent handbook. I/We also understand that my/our child is being accepted on a month trial basis. During this time, the staff will make observations and evaluations pertaining to the child’s ability to adapt to the school surroundings. Unless otherwise notified, the child/children will be accepted and permanently enrolled. I/We further understand that if the policies outlined in this handbook were not adhered to, it would be sufficient cause for the removal of the child/children from the program.
  
  I/We also agree to give a minimum of one month written notice of my/our intent to withdraw my/our child/children from the program. If one month notice is not given, I/we agree to make full tuition payment for the final month.
*

I/we understand that I/we must provide a completed medical form to the school.
Health Care Summary
Immunization Record
*

I/we understand Winter, spring & summer breaks, holidays and absence will be charged at full tuition for Preschool, Pre-K program. Summer school is charged for the days I have registered.
*

I/we understand payment is due on 1st of each month. Late fee or returned payment fee due to insufficient fund is $25.
*

I/we understand the late pickup fee (after 5:30pm) is $1 per minute.
*

I/we understand the vacation policy.
*

I/we understand the meal policy.
*

I/we understand the illness policy.
*

I/we understand the behavior policy and I/we have read and shared the preschool rules with my/our child/children.
*

I/we have read and understand the photograph policy.
*

I/we have read and understand the field trip policy.
*

I/We understand there is 30 days advanced notice to withdraw from the program.
Signature of Parent/Guardian *

Clear
Date *

Month Day Year

Non-refundable registration fee $80 per child. (Please note we are unable to hold the spot until registration fee is received.)

Registration Fee $ 80.00

Quantity

Total $ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Sleepy Tigers Chinese Immersion Learning Center School Age Care Enrollment Form

Acknowledgement