CHILD INFORMATION

Have you ever been a Playgarden Class, Playground or Camp member? *
YesNo

PARENT/GUARDIAN information

Emergency Contact

CAREGIVERS / Additional authorized
Pick-up

Medical information

Does your child have any dietary restrictions or requirements? *
YesNo

Does your child suffer from any known allergies? *
YesNo

Does your child have any serious conditions in her/his medical history, for example asthma, diabetes, epilepsy, surgery? *
YesNo

Does your child have any special needs? Is there anything else we should know about your child?

PERSONAL INFORMATION

Does the applicant have siblings? *
YesNo

Is your child supervised by adults other than parents? *
YesNo

Does your child regularly socialize with other children? *
YesNo

What types of activities do you do together as a family?

What are your child’s favorite foods and regular meal times?

What time does your child go to bed at night and wake up in the morning? What time does your child take a nap?

Is your child potty-trained? *
"Yes, completely""We're working on it""Not yet"

Has your child ever been dropped off before? *
YesNo

Is there anything else you would like us to know about your child or your family?

BINDING AGREEMENT

I understand Playgarden Prep will take all necessary precautions to ensure the safety of my child and that the school cannot be responsible for any injury my child may incur while in attendance. *
I agree
I give permission for the staff of Playgarden Prep to administer first aid and/or CPR to my child. *
I agree
I give permission to the staff of Playgarden Prep to request medical assistance from the emergency section of the nearest hospital, if my child sustains an injury while in attendance at School, and I am unavailable or if the designated emergency contact person cannot be reached. *
I agree
I agree to all provisions in the Playgarden Enrollment Agreement *
I agree