March, 2018

Dear parents,

On behalf of all of us at Kid’s Village Pre-School and Now LOYOLA Arts Preschool, it is our pleasure to invite you to recommit your child for the upcoming 2018-2019 Academic School Year.

In order to secure your child’s space for the next school year, please fill out the enclosed application or contact us for availability.

We hope that your child and you are enjoying a positive learning and growing experience with us, as we continually strive to meet our mission of academic excellence and develop Body, Mind and Spirit through the Arts and now whit our new ingredient – Religion Formation –

Thank you for your sustained commitment to kid’s Village Arts Pre-School now LOYOLA Preschool and Elementary.


LOYOLA Preschool – (Kid’s Village Arts PreSchool)

Registration form Program Year 2018-2019





Age: ___________Birthday: _________________Sex: ________________


Child lives With:____________________


Mother’s first name: __________________ Father’s first name: ___________________

Mother’s last name:  __________________ Father’s last name: ___________________

Home phone________________________   Home Phone: ________________________

Address: __________________________              Address: ____________________________

Employer: _________________________           Employer:___________________________

Mother’s work: _____________________    Father’s work: _______________________

Mother’s Cel.: ______________________    Father’s Cel. : ________________________

E-mail Address:__________________________________________________________

Custody:   Mother_____          Father_____   Both __________ Other ______


Medical information:  I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.

Doctor: ____________________________ Address: ___________________________

Phone: _______________

Doctor: ____________________________ Address: ___________________________

Phone: _______________

Dentist: ____________________________ Address: ___________________________  Phone:________________

Hospital Preference:  ______________________________________________________


Please List allergies, special medical or dietary needs, or other areas of concern:




Contacts:  Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident, or emergency, if for some reason the custodial parent or legal guardian cannot be reached:



Name                          Address                            work                        home



Name                         Address                            Work                        Home


Name                         Address                          Work                             Home



Name                        Address                           Work                             Home






Helpful Information about Child:









Section   65C –22.006 (2), F.A.C., requires a current physical examination (form DH 3040) and immunization record (Form DH 680 or DH 681) within 30 days of enrollment.


Section 402.3125(5), FS., requires that parents are notified in writing  of the disciplinary practices used by the child care facility.


Section 65C-20.11(2)(c)(1), F.A.C., requires that parent(s) receive a copy of the family day care home brochure, “Selecting A Family Day Care Home Provider” (CF/PI 175-28)


Section 65C-22.006(3)(c)2., F.A.C. requires that parents are notified in writing of disciplinary practices used by the child care facility, or


Section 65C-20.010(6)(c), F.A.C., requires that a written a copy of the family day care provider’s discipline policy be available for review by the parent(s).


By signing below, you verify that you have received the above items and that all information on this enrollment form is complete and accurate.


Please complete registration, to ensure space you must make payment with the registration form to Doral Conservatory and School of the Arts.




Signature of parent\ guardian                                            Date



Name: ____________________________ Driver’s license:______________________





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