Registration Form * = Required Fields Child Information Child's Full Name* Name Child Goes By* Date of Birth* Sex*MaleFemale Child's Primary Language* Other Languages Spoken At Home* Major Medical Concerns/Allergies* Home Address* Which class are you registering for:*—Please choose an option—5 day Morning Pre-K Ages 4/5+ Monday through Thursday, 9:00 am - 12:00 pm -- $550/month I confirm my child is an independent toilet user* Parent or Guardian Information We require a minimum of two emergency contacts. Primary Contact Name* Relation to child:*—Please choose an option—FatherMotherGuardian Address*Same as ChildNew Address Email* Cell Phone Work Phone Occupation and place of employment Secondary Contact Name* Relation to child:*—Please choose an option—FatherMotherGuardian Address*Same as ChildNew Address Email* Cell Phone Work Phone Occupation and place of employment Releases Emergency Procedures*: I authorize NHCA to contact emergency care for my child and authorize any medical professional to take the necessary measures for my child's life in case of life threatening situations. I understand that I will be contacted as soon as possible. Confidentiality*: I give permission to NHCA to release information from my child's file to the emergency care personnel. I give permission for information to be given to the administration of NHCA from my child's physician or other professional sources in the even of an emergency transfer. Photo Release: My permission is given for photographs and video to be taken of my child during preschool activities. These images may be used in our preschool's promotional video and/or end of year yearbook/slideshows and other promotional purposes. Some class projects may require photos as well. Please note that clicking submit will act as an electronic signature for the purposes of this form.