Enrollment form

Circle of Friends Preschool and Kindergarten

702 NE Norton Ave. Bend OR   541-389-5475  e-mail: office@circleoffriendsbend.com

Application for Enrollment                 Date Rcvd._________

                                    Amt. Paid _________

Child’s Name ________________________________________________

Birth date _______________    Birth Place _________________________

Morning Program Selection:

     Red Rose Kindergarten class (5 – 6 yr old)    Full time   /   Part time

Sunflower Preschool Class  (4 turning 5)  Full time   /    Part time

Part time: Days of the week requested (circle choices):   M    T    W    H     F

                                3, 4 or 5 day options   (M or F required for 3 day slot)

          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Morning Glory Preschool Class (3 turning 4)    Full time   /    Part time

Blue Bell Nursery Class (30 months/older)       Full time   /    Part time

             2, 3, 4 or 5 day options: (circle choices):       M      T     W      H      F

(Monday or Friday required for a 3 day slot)

Before and Aftercare Needs:

    7:45 – 9:00 am _____________     1 pm – 5:45 pm _______________

Full Time? _____  Part-time? (days/times if known) ______________________

       Information About The Family

Parent Name  ___________________________  Home # _________________

Address  ______________________________     Cell #  __________________

_____________________________________     Work #__________________

Place of Work ___________________________  Occupation ______________

E-Mail : __________________________________________________

Parent Name  ___________________________  Home # _________________    Address  _______________________________   Cell #  __________________

(if different)______________________________   Work #__________________

Place of Work ___________________________  Occupation _______________

E-Mail: __________________________________________________

Siblings (names and ages)______________­­­_______________________________

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Emergency Information

Emergency contact persons (in case the parents cannot be reached)

Name _____________________________ Phone ______________________

Name _____________________________ Phone ______________________

Doctor ____________________________ Phone _______________________

Any Known Allergies to medications? _______________________________________
Interests and/or Talents?  _______________________________________________

____________________________________________________________________

What do you consider your child’s strongest aptitude and traits of character?  ________________________________________________________________

________________________________________________________________

Hours of ‘screen time’ including tv, video, computer? daily? ______ weekends?______

Other Information

List people, other than parents, to whom your child may be released on a regular basis:

Name                                 Relationship                                  Phone

__________________________________________________________________________________________________________________________________________

What have you read or heard about Waldorf Education? _______________________
____________________________________________________________________

How did you hear about Circle of Friends?  _________________________________

____________________________________________________________________

Medical Information

General Health (describe) ______________________________________________

Does child have any known allergies or food sensitivities? ______________________
____________________________________________________________________

Does child have any physical challenges or extraordinary conditions? _____________

____________________________________________________________________

Please list major illnesses, childhood diseases, accidents, etc. __________________
____________________________________________________________________

Current Medications _______________________________________________

Signature of Parent Guardian ______________________________Date____________

To Register:  Please fill out this form completely and submit with yearly

Registration Fee of $ 90.00 (make checks to Circle of Friends)

 Questions?  Just call the school at  541 389-5475  Thanks!

Circle of Friends admits students of any race, creed, physical handicap,

national or ethnic origin.

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