Admission Information

General Information

Child’s Full Name *

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Child’s Date of Birth*

Child’s Home Address*

Name of Father *

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Father’s Address*

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Father's Email Address*

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Father's Home Phone / Mobile Phone*

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Name of Mother*

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Mother’s Address*

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Mother’s e-mail*

Mother's Home Phone / Mobile Phone*

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Give the name, address, and phone number of the responsible individual to call in case of an emergency when parents cannot be reached.

Emergency Contact Name*

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Address*

Home Phone *

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Mobile Phone*

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Children will be released to parents. If you would like the school to release your child to any other person, they must be listed below. Any person not known to staff must present valid identification.

Name*

Phone Number*

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Name*

Phone Number*

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Name*

Phone Number*

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Page 2

Admission Information

Receipt of Written Operational Policies and Parent Handbook

Discipline and guidance
Procedures for release of children
Behaviors that might lead to expulsion
Illness and exclusion criteria
Emergency Plans
Procedures for dispensing medication

Immunization requirements for children
Meal and snack practices
Procedures for parents to discuss concerns with the director
Procedures for parents to participate in operation activities
Procedures to visit the center without securing prior approval

Authorization for Emergency Medical Attention

In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:

Address of Facilit*

Phone Number*

Name of Child’s Physician*

Phone Number*

I give my consent for the facility to secure any and all necessary emergency medical care for my child.

Page 4

Admission Information

Vaccine Information

Please provide a copy of your child’s most current vaccination records.*

Date ×

Requirements for Exclusion*

I have attached a signed and dated affidavit stating that I decline immunizations for reason of conscience, including religious belief of a recognized religious organization, to which I adhere or am a member.

have attached a signed and dated affidavit stating that the vision or hearing screening conflicts with the tenets or practices of a recognized religious organization to which I adhere or am a member.

Medical Admission Requirements

One of the following must be presented when your child is admitted to the School or within one week of admission.

Check Only One option:*

Health Care Professional’s Statement: I have examined the above-named child within the past year and find that he or she is able to take part in the School’s program.

A signed and dated copy of a Health Care Professional’s statement is attached.

Medical diagnosis and treatment conflict with the tenets and practices of a recognized religious organization, which I adhere to or am a member of. I have attached a signed and dated affidavit.

My child has been examined within the past year by a Health Care Professional and is able to participate in the School’s program. Within 12 months of admission, I will obtain a Health Care Professional’s signed statement and submit it to the School.

Name of Health Care Professional *

Address of Health Care Professional*

Parent’s Signature

Date*

Admission Information

General Information

Give the name, address, and phone number of the responsible individual to call in case of an emergency when parents cannot be reached.

Children will be released to parents. If you would like the school to release your child to any other person, they must be listed below. Any person not known to staff must present valid identification.

Page 2

Admission Information

Receipt of Written Operational Policies and Parent Handbook

Discipline and guidance
Procedures for release of children
Behaviors that might lead to expulsion
Illness and exclusion criteria
Emergency Plans
Procedures for dispensing medication

Immunization requirements for children
Meal and snack practices
Procedures for parents to discuss concerns with the director
Procedures for parents to participate in operation activities
Procedures to visit the center without securing prior approval

Authorization for Emergency Medical Attention

In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:

I give my consent for the facility to secure any and all necessary emergency medical care for my child.

Page 3

Admission Information

Child’s Additional Information Section

Parent’s Signature

Medical Admission Requirement

Texas State Law requires pre-school age children to have a vision and hearing screening. Timing will depend upon the child’s age and date of birth.

Vision Exam Results

Hearing Exam Results

Parent’s Signature

Page 4

Admission Information

Vaccine Information

Medical Admission Requirements

One of the following must be presented when your child is admitted to the School or within one week of admission.

Parent’s Signature

Your form has been submitted

Quick links

Get in Touch

All Rights Reserved © Red Oak 2022

Admission Information

General Information

Give the name, address, and phone number of the responsible individual to call in case of an emergency when parents cannot be reached.

Children will be released to parents. If you would like the school to release your child to any other person, they must be listed below. Any person not known to staff must present valid identification.

Page 2

Admission Information

Receipt of Written Operational Policies and Parent Handbook

Discipline and guidanceProcedures for release of childrenBehaviors that might lead to expulsionIllness and exclusion criteriaEmergency PlansProcedures for dispensing medication

Immunization requirements for childrenMeal and snack practicesProcedures for parents to discuss concerns with the directorProcedures for parents to participate in operation activitiesProcedures to visit the center without securing prior approval

Authorization for Emergency Medical Attention

In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:

I give my consent for the facility to secure any and all necessary emergency medical care for my child.

Page 3

Admission Information

Child’s Additional Information Section

Parent’s Signature

Medical Admission Requirement

Texas State Law requires pre-school age children to have a vision and hearing screening. Timing will depend upon the child’s age and date of birth.

Vision Exam Results

Hearing Exam Results

Parent’s Signature

Page 4

Admission Information

Vaccine Information

Medical Admission Requirements

One of the following must be presented when your child is admitted to the School or within one week of admission.

Parent’s Signature

Your form has been submitted

Quick links

Get in Touch

All Rights Reserved © Red Oak 2022

Discipline and guidance
Procedures for release of children
Behaviors that might lead to expulsion
Illness and exclusion criteria
Emergency Plans
Procedures for dispensing medication

Immunization requirements for children
Meal and snack practices
Procedures for parents to discuss concerns with the director
Procedures for parents to participate in operation activities
Procedures to visit the center without securing prior approval