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<br />MEDICAL <br /> <br />Please list any known allergies or health concerns your child may have. <br /> <br />PARENTAL PERMISSION <br /> <br />Please list name and telephone of person who is AUTHORIZED to pick up your child. <br /> <br />1. <br /> <br />Telephone <br /> <br />2. <br /> <br />Telephone <br /> <br />3. <br /> <br />Telephone <br /> <br />Please list anyone who is NOT AUTHORIZED to pick up your child. <br /> <br />Please state how FIRST STEP may reach you while your child is attending preschool: <br /> <br />Please list name, address, and telephone number of TWO persons to be contacted if parent cannot be reached: <br /> <br />1. <br /> <br />NAME <br /> <br />2. <br /> <br />ADDRESS <br /> <br />TELEPHONE <br /> <br />PERMISSION AUTHORIZATIONS <br /> <br />I give permission to the school for the following: <br /> <br />To secure medical help in the event of an emergency situation when parents cannot be reached or there will be a <br />delay in arrival. <br /> <br />To administer Syrup ofIpecac under the direction ofthe Regional Poison Control Center, in the event of an <br />accidental poisoning. <br /> <br />Signature <br /> <br />Date <br /> <br />TUITION AGREEMENT <br /> <br />I agree to the following terms and conditions: <br /> <br />I am responsible for and agree to pay a registration fee of$40.00 and understand that this registration fee is <br />non-refundable. <br /> <br />I am responsible for and agree to pay the monthly tuition rate for my child's program. I understand that full <br />tuition is due on the 15th before the month. <br /> <br />Signature <br /> <br />Date <br />