Sleepy Tigers CILC Summer School

Sleepy Tigers Chinese Immersion Learning Center Summer School Age Enrollment Form
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 Date Picker Icon
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 Date Picker Icon
Grade in Upcoming School Year
Fist Day of School *

Month Day Year Date Picker Icon
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
Summer School Schedule Request
(3 days a week & 4 consecutive weeks minumum)
Week 1: 6/15-6/19

Monday Tuesday Wednesday Thursday Friday
Week 2: 6/17-6/21

Monday Tuesday Wednesday Thursday Friday
Week 3: 6/22-6/26

Monday Tuesday Wednesday Thursday Friday
Week 4: 6/29-7/2

Monday Tuesday Wednesday
Week 5: 7/6-7/10

Monday Tuesday Wednesday Thursday Friday
Week 6: 7/13-7/17

Monday Tuesday Wednesday Thursday Friday
Week 7: 7/20-7/24

Monday Tuesday Wednesday Thursday Friday
Week 8: 7/27-7/37

Monday Tuesday Wednesday Thursday Friday
Week 9: 8/5-8/9

Monday Tuesday Wednesday Thursday Friday
Week 10: 8/3-8/7

Monday Tuesday Wednesday Thursday Friday
Week 11: 8/10-8/14

Monday Tuesday Wednesday Thursday Friday
Week 11: 8/17-8/21

Monday Tuesday Wednesday Thursday Friday
Week 11: 8/24-8/28

Monday Tuesday Wednesday Thursday Friday
Comment:
General Information
Lunch Option *

School Lunch ($4.5 / meal for school age Home Lunch
Payment Schedule *

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

School Age K-3, $46/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 Date Picker Icon

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
Expiration Month	Expiration Year

Should be Empty: