Parking  |  Tickets  |  Join

Nature Preschool Enrollment/Emergency/Health Form

I give my child permission to participate fully in this program. This includes visits to other rooms and space in the Education Center and on the Regenstein Foundation Learning Center Campus, such as the ITW Kitchen Classroom, Nature Laboratory, Grunsfeld Growing Garden, etc. It will also include hiking on trails, visiting other spaces within the garden, and riding the tram or trolley.
Person to Contact in an Emergency
Alternate Emergency Contact
Emergency Authorizations
I attest that my child is in good physical and mental health. Any special considerations are indicated below. In case of accident or illness, I hereby give permission that my child may be given emergency treatment and, further, I authorize and consent to the administration of any and all medical, dental, and surgical examinations or operations and treatment or all other related care, including the administration of drugs, tests, anesthesia, and/or blood transfusions to the above named child that may be ordered by the medical care provider in attendance at the facility deemed necessary for medical treatment. I hereby consent to the release of medical report(s) to any medical care provider and consent to the admission of the above-named child to a hospital. I agree to be responsible for any medical expenses incurred on behalf of my child.
Medical History
IMPORTANT: Please describe any special health considerations including, but not limited to, allergies, physical or behavioral conditions that may affect your child's participation in school in the section below. If during the school year changes to your child’s health occur you are responsible for contacting the staff with up dated information.

What allergies does your child have? Please be specific as to the severity and treatment. If none, indicate "none" in the field below.

(Asthma, prescription Benadryl, epi pen) If yes, you will be given an Individual Care Plan for your child to be completed before starting school.
I give permission for the staff to administer medication indicated below to my child:

Please describe any physical, mental, behavioral, or psychological conditions requiring medication, treatment or for which your child is under the care of a doctor or health practitioner.

Likes, dislikes, fears, separation issues
Carpool/pick-up authorizations
NOTE: Written notification by parents or guardian MUST be given for pick-up by someone other than persons listed. If your carpool changes during the school year, complete a new form. Please let us know in advance if there are any issues regarding pick-up/drop-off of which we should be aware (custody disputes, etc.).

I understand that by completing and submitting this Medical Form via electronic transmission that I acknowledge the above statements and my submission of this form on-line shall substitute for and have the same legal effect as an original form signature.

By registering for Nature Preschool, I agree to the terms and conditions as outlined in the School Guidelines.