Arts Together Preschool Registration

Preschool Online Registration
Please do not print this form. This form is for online registration only. If you wish to print out a form to mail, fax, or drop by Arts Together please click here.

Use the TAB key to move through the fields. Pressing ENTER or RETURN will submit the form prematurely. A confirmation will follow receipt of this registration and fees.

Student's Name

Date of Birth

Current Age

Male Female

Racial/Ethnic Identity or Indentities(Our funding sources request this information from us.)

Father's Name

Father's Home #

Father's Work #

Father's Cell #

Mother's Name

Mother's Home #

Mother's Work #

Mother's Cell #

Mail to Name

Street Address

City

Zip

E-mail Address

Student's Home #

In case of emergency, we will call parents first, whom should we call after or other than the parents?
First Contact Name

Home #

Work #

Cell #

Hospital Preference

Physician

Phone

List any medical problems or concerns that the teachers and staff need to be aware of

Any known allergies?

Any medications that your child is currently taking?

Arts Together Waiver of Liability
I hereby release Arts Together, Inc., its employees, volunteers, and board members from any and all liability, cost or expense associated with an injury my child may sustain while participating in the Arts Together program. In case I cannot be reached in an emergency, I give permission to Arts Together to seek medical treatment for my child. I give permission to Arts Together to use for publications, any photo in which a family member appears. I have read and understand Arts Together policies.
Signature (type in name)

Payment of the $200 non-refundable registration fee is required when submitting your online registration.

Multi-Arts Preschool:

Two Days (T/T) per week – mornings (9am-Noon)
$185 per month

Three Days (TWTh) per week– afternoons (1-4pm)
$245 per month

Three Days (MWF) per week – mornings (9am-Noon)
$245 per month

Five Days (M-F) per week– mornings (9am-Noon)
$355 per month

Registration Fee

When will you pay?

$ monthly total (eight payments with the first due by September 1 then the remaining seven payments due October through April)

OR

$ semi-annually (two payments due by September 1, 2009 and January 4, 2010) OR

$ annually (due by September 1, 2009)

Please accept my tax-deductible contribution to Arts Together’s Scholarship Fund:

Mastercard Visa Card Account#

Exp.Date

3-Digit Verification Code

Print Cardholder's Name

Signature

AMOUNT OWED

AMOUNT PAID

How did you hear about our program?

WE WILL NOT BE BILLING YOU.
Preschool payments are due on the first of each month, September through May, for a total of nine payments. You will not be billed. Withdrawal from preschool requires one month notice.

By clicking the "submit registration" button you are authorizing Arts Together to charge your credit card the total in the AMOUNT PAID field. This registration will be sent via e-mail to the Arts Together office.

If you wish, this form can be sent by email and your credit card number can be faxed separately to 833-5218.

Questions? Call 828-1713 or e-mail info@artstogether.org