Haymarket Children's Academy
Home
About us
About us
Curriculum
Security
The Outpost
Programs
Nursery
Preschool
Kindergarten
Before & After School
Summer Camp
Meet Our School
Resources
New Parents
Nutrition
Pricing & Scheduling
Blog
Contact us
Home
About us
About us
Curriculum
Security
The Outpost
Programs
Nursery
Preschool
Kindergarten
Before & After School
Summer Camp
Meet Our School
Resources
New Parents
Nutrition
Pricing & Scheduling
Blog
Contact us
Menu
Home
About us
About us
Curriculum
Security
The Outpost
Programs
Nursery
Preschool
Kindergarten
Before & After School
Summer Camp
Meet Our School
Resources
New Parents
Nutrition
Pricing & Scheduling
Blog
Contact us
571-261-2020
REGISTRATION DOCUMENTS
Home
/
Registration Documents
Fill the form Registration
Child #1 Name*
DOB*
Gender*
Select
Male
Female
Child #2 Name
DOB
Gender*
Select
Male
Female
Parent / Guardian*
Phone: (c)*
Phone: (w)*
Place of Employment
Address (Same as child)
Email
Parent / Guardian
Phone: (c)
Phone: (w)
Place of Employment
Address (Same as child)
Email
Physician
Phone
Address
Preferred Hospital
EMERGENCY CARE AUTHORIZATION
I authorize Haymarket Children's Academy to provide all emergency measures for the care and protection of my child while under their supervision. In case of a medical emergency, I understand that my child may be transported to an appropriate medical facility by the local emergency unit for treatment. It is understood that in some medical situations, the staff will need to contact the local emergency resource before the parent, child's physician, and/or adult acting on the parent's behalf.
Name*
Date
MEDICATION AUTHORIZATION
I authorize an employee at Haymarket Children's Academy who possesses the necessary certification (i.e. MAT trained) to administer medication as ordered by my child's physician either verbally or in writing while my child is being cared for at Haymarket Children's Academy.
Name*
Date
PHOTOGRAPH AND VIDEO AUTHORIZATION
I authorize the Haymarket Children's Academy to use any photograph or video of my child on its Social Media (Facebook and Website)
Name
Marketing Materials
EMERGENCY CONTACTS
Two People (other than the parents) to be contacted in case of emergency and authorized to pick up the child:
Name*
Phone
Address
Name*
Phone
Address
Other People Authorized for Pickup
Adminsteration
Class
Date of Enrollment*
Reg. Paid
Submit