Sleepy Tigers CILC Summer School

Sleepy Tigers Chinese Immersion Learning Center Summer School for School Age Children

(K-5. Students need to be at least 6 years old, currently in Kindergarten, entering 1st grade in the fall.)
Name of Child 1 *

First Name Last Name
Child 1 Gender *

Male Female
Child 1 Birth Date *

Month Day Year
Entering Grade *
School Attending
Name of Child 2

First Name Last Name
Child 2 Gender

Male Female
Child 2 Birth Date

Month Day Year
Entering Grade
School Attending
Home Language *

Mandarin Cantonese English Spanish French German Arabic Russian Other Language
We celebrate (holidays):
Please share more about your child and your family:
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
Summer School Schedule Request

(minimum 3 days a week, and 4 consecutive weeks)
Week 1: 6/7-6/11

Monday Tuesday Wednesday Thursday Friday
Week 2: 6/14-6/18

Monday Tuesday Wednesday Thursday Friday
Week 3: 6/21-6/25

Monday Tuesday Wednesday Thursday Friday
Week 4: 6/28-7/2

Monday Tuesday Wednesday Thursday Friday
Week 5: 7/6-7/9

Tuesday Wednesday Thursday Friday
Week 6: 7/12-7/16

Monday Tuesday Wednesday Thursday Friday
Week 7: 7/19-7/23

Monday Tuesday Wednesday Thursday Friday
Week 8: 7/26-7/30

Monday Tuesday Wednesday Thursday Friday
Week 9: 8/2-8/6

Monday Tuesday Wednesday Thursday Friday
Week 10: 8/9-8/13

Monday Tuesday Wednesday Thursday Friday
Week 11: 8/16-8/20

Monday Tuesday Wednesday Thursday Friday
Week 12: 8/23-8/27

Monday Tuesday Wednesday Thursday Friday
Comment:
Starting Date *

Month Day Year
Date
General Information
Lunch Option *

Home Lunch School Lunch $6.00/meal
Payment Schedule *

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

School Age K-5, $55/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:
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
Sunscreen / Cream Permission: I give Sleepy Tigers Chinese Immersion Preschool permission to administer sunscreen to my child. I will provide sunscreen with my child’s name written on the bottle. I will verbally notify the Teacher/Director when my child needs sunscreen / cream and will make every effort to apply sunscreen / cream before my child arrives at school.
Sunscreen / Cream Permission:

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 / Schoool Age Care is charged for the days I have registered.
*

I/we understand payment is due on 1st of each month. Late fee or returned / denied 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 a $10 fee will be charged for each time switching or changing attendance schedule.
*

I/we understand the vacation policy.
*

I/we understand that I/we can change lunch option on a monthly basis, I/we need to notify school before the 20th of each month for the following month lunch option change.
*

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 15 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

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Sleepy Tigers Chinese Immersion Learning Center Summer School for School Age Children

Acknowledgement