Tribú Global Learning Academy

Enrollment Registration

Enrollment Registration
Name of Child*
First Middle Last
Nickname
Age*
Sex*
Date of Birth (MM/DD/YYYY)*
Child’s Primary Language*
Home Phone*
Home Email Address*
Parent/Guardian’s Primary Language*
Child’s Home Address*
Street Address City State / Province / Region ZIP / Postal Code
Parent/Guardian Marital Status*
- Single
- Married
- Divorced
- Widowed
Primary Residence*
- Mother
- Father
- Both
- Guardian
List the family members your child lives with—include names and ages of siblings*
Select the schedule:*
- A.M. (8:30-12 pm)
- P.M. (12:30 pm - 4 pm)
- FULL DAY: (8:30 am-4 pm)
Days to Attend:*
- A.M. (8:30-12 pm) - Monday
- A.M. (8:30-12 pm) - Tuesday
- A.M. (8:30-12 pm) - Wednesday
- A.M. (8:30-12 pm) - Thursday
- A.M. (8:30-12 pm) - Friday
Days to Attend:*
- P.M. (12:30 pm - 4 pm) - Monday
- P.M. (12:30 pm - 4 pm) - Tuesday
- P.M. (12:30 pm - 4 pm) - Wednesday
- P.M. (12:30 pm - 4 pm) - Thursday
- P.M. (12:30 pm - 4 pm) - Friday
Days to Attend:*
- FULL DAY: (8:30 am-4 pm) - Monday
- FULL DAY: (8:30 am-4 pm) - Tuesday
- FULL DAY: (8:30 am-4 pm) - Wednesday
- FULL DAY: (8:30 am-4 pm)- Thursday
- FULL DAY: (8:30 am-4 pm) - Friday
Early Care (7:30-8:30 am)*
- Yes
- No
Days to Attend:*
- Early Care (7:30-8:30 am) - Monday
- Early Care (7:30-8:30 am) - Tuesday
- Early Care (7:30-8:30 am) - Wednesday
- Early Care (7:30-8:30 am) - Thursday
- Early Care (7:30-8:30 am) - Friday
PM Enrichment: (4-6 pm)*
- Yes
- No
Days to Attend:*
- PM Enrichment: (4-6 pm) - Monday
- PM Enrichment: (4-6 pm) - Tuesday
- PM Enrichment: (4-6 pm) - Wednesday
- PM Enrichment: (4-6 pm) - Thursday
- PM Enrichment: (4-6 pm) - Friday
Does your child attend school?*
- Yes
- No
School Address*
Street Address City State / Province / Region ZIP / Postal Code
School Phone*
School Start Time*
School End Time*
PRIMARY CONTACT AND RELEASE PERSONS
Arrival Time*
Departure Time
Lunch*
P.M. Snack*
Parent/Guardian #1
Parent/Guardian #1 Name*
First Last
Relationship to Child*
Home Phone*
Cell Phone*
Home Address*
Same as child's address

Street Address City State / Province / Region ZIP / Postal Code
Home Email Address*
Employer*
Work Phone/Extension*
Parent/Guardian #2
Parent/Guardian #2 Name*
First Last
Relationship to Child*
Home Phone*
Cell Phone*
Home Address*
Same as child's address

Street Address City State / Province / Region ZIP / Postal Code
Home Email Address*
Employer*
Work Phone/Extension*
Parent/Guardian Signature*
Date*
Date Format: MM slash DD slash YYYY
EMERGENCY CONTACT AND RELEASE PERSONS

Please list the persons you would like contacted (in order of priority) if you cannot be reached in case of emergency. Check the “Emergency Contact and Release” box, as the persons listed will also be authorized to pick up or accompany the child for the purposes of medical treatment. We will not release a child to anyone (other than the parent) under the age of eighteen (18), including siblings. Additionally, please list the persons you would like to be authorized for pick-up only on a given day (i.e., babysitter). For these persons, check the “Release Only” box. For the safety of your child, we will request all authorized release persons with whom staff are not familiar to provide government-issued photo identification at the time of pick-up.

If you want a person who is not identified above to pick up your child, you must notify school staff in advance, in writing. Your child will not be released without prior authorization. In the event you call a pick-up authorization into the school because you are unable to submit your authorization in writing, we will use your personal information from this packet to verify your identity.
Contact #1 Name*
Relationship to Child*
Home Phone*
Cell Phone*
Home Address*
Gov Issue Photo ID Type*
Check the box beside the box:*
- Emergency Contact and Release
- Release Only
Contact #2 Name
Relationship to Child
Home Phone
Cell Phone
Home Address
Gov Issue Photo ID Type
Check the box beside the box:
- Emergency Contact and Release
- Release Only
AUTHORIZATION FOR MEDICAL TREATMENT OF A MINOR
In the event of a medical issue requiring a physician’s care, would you like us to call your family physician?*
- Yes
- No
Physician’s Name*
Phone Number*
Address*
Street Address City State / Province / Region ZIP / Postal Code
Consent*
I (we) do hereby state that I am (we are) parent(s)/legal guardian(s) of my child, who resides with me (us). I (we), authorize, for emergency purposes only, a school-designated employee to transport the above minor by ambulance and consent to any necessary examination, anesthetic, medical diagnosis, surgery or treatment, and/or hospital care to be rendered to the minor under the general supervision of any physician or surgeon licensed to practice medicine in the State of
Preferred Hospital/Clinic for Acute Care and Emergency Care*
Dentist Name*
Practice/Clinic Name*
Address*
Phone*
Health Insurance Provider and Policy Number*
Last Tetanus/Diptheria Booster*
Allergies to Drugs, Foods
Please list any special medications or pertinent information:
Parent/Guardian Signature*
Date*
Date Format: MM slash DD slash YYYY
Child Profile

You know your child better than anyone else in the world! You have observed your child on a day-to-day basis and are uniquely qualified to share your insight about your child’s development with us. Please take a moment to complete this profile, as the information will help us know your child better and to meet his or her individual needs.
With whom does the child reside? Please list names and relationships to child, and names and ages of other children:
Name Relationship Age
Who also cares for your child(ren)?
What language is spoken in your home?
When did your child begin speaking or using words?
What would you like most for your child to experience with us?
How would you describe your child (personality characteristics)?
What do you enjoy the most about your child?
What are your child’s play interests (preference for creative, dramatic, or construction play)?
How does your child express frustration?
Does your child have any particular fears?
How does your child react to change (such as being left by parents)?
How does your child comfort himself/herself?
How do you discipline your child?
What are the foods your child likes best?
What are the foods your child likes least?
What are your child’s mealtime routines at home?
How many hours of sleep does your child receive at night?
Does your child need to be awakened in the morning to attend the school?
Signature*
Date*
Date Format: MM slash DD slash YYYY
What are your child’s sleeping arrangements? Check appropriate answer.
- Own room
- Shares room with
- Sleeps in crib
- Sleeps in bed
Sleeps in crib
What are your child’s bedtime rituals?
Does your child take naps?
- Yes
- No
How long?
Does your child need a comfort item for a nap?
- Yes
- No
If yes, what is that specific item?
Is your child toilet-trained?
- Yes
- No
Explain
What language do you use to discuss toileting in your house?
Has your child had previous preschool experiences?
Are you available to help us with field trips or other special events?
- Yes
- No
Do you have a special interest or hobby you would like to share with the children?
What family or cultural traditions are important in your home?
Would you be willing to share these traditions with the children?
Is there anything else you would like us to know about your child that would help us better meet their needs?
Registration Fee
Price: $75.00
How would you like to pay the registration fee?*
- Cash
- Check
- Online
Parent/Guardian Signature*
Date*
Date Format: MM slash DD slash YYYY

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Name	Relationship	Age

Tribú Global Learning Academy

Enrollment Registration

PRIMARY CONTACT AND RELEASE PERSONS

Parent/Guardian #1

Parent/Guardian #2

EMERGENCY CONTACT AND RELEASE PERSONS

AUTHORIZATION FOR MEDICAL TREATMENT OF A MINOR

Child Profile

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