Parent Name (main contact) *

First Name

Last Name

Secondary Parent Name (optional)

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Childs Name *

First Name

Last Name

Childs Birthdate *

MM

DD

YYYY

Has your child had previous experience with preschool? *

Yes

No

Emergency Contact *

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

In an emergency, Oakland Cooperative Playschool has my permission to call an ambulance or take my child to any available physician or hospital at my expense? *

Yes

No

Oakland Cooperative Playschool has my permission to take photos of my child for the OCP yearbook. *

Yes

No

Oakland Cooperative Playschool has my permission to use my childs name, photos, and/or videos for use in the media. (OCP Facebook page, newspaper articles, fundraising, thank you cards, etc.) *

Yes

No

Release of Liability - I understand that liability insurance carried by the Oakland Cooperative Playschool covers only enrolled children and/or parent helpers. I am aware that I am responsible for supervisiong any additional children, such as siblings, that may accompany me to the playschool, and I release the Oakland Cooperative Playschool from liability for any accidents or injuries that may occur. This release applies to parent meetings, board meetings, an/or any special activities sponsored by the Playschool. *

I agree

I disagree

First month's tuition is due by orientation. Supply and Registration fees are due now, and no payment will prolong contact post submitting enrollment form. *

I understand and agree to pay registration and supply fees