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571-261-2020
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newstudent@haymarketca.com
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Child #1 Name
DOB
Gender
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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)
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
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Home
About Us
Curriculum
Nutrition
pickup & drop-off
Security
Pricing & Scheduling
Programs
Online Remote Learning Program
Nursery
Preschool
Pre-K
Private Kindergarten
Before / After School
Childcare
Summer Camp
New Parents
Contact
Blog
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Your Name
Email
What day and time would you like to tour the school?
Date
Time
What are the names and dates of birth of your children?
Child Name
Date
Child Name
Date
Child Name
Date
Child Name
Date
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