THE DISCOVERY SCHOOL

APPLICATION OF ENROLLMENT

Child's Name: _________________________________________________ Date:____ /_____ /_____
Child prefers to be called: ________________________________________
Date of Birth: ____________ Home Phone: ______________ Cell or Pagers: ______________________
Home Address: ______________________________________ City: ____________ Zip Code:_______

Parent's Names: _____________________________________________________________________

Mother' s occupation:_____________________________ Email_______________________________
Place of Business: _______________________________________Business Phone: ________________
Business Address: ____________________________________ City: ____________ Zip Code:_______
Social Security Number:_________________ Texas Driver's License No.: ________________

Father's Occupation: ______________________________ Email______________________________
Place of Business: _______________________________________Business Phone: ________________
Business Address: ____________________________________ City: ____________ Zip Code:_______
Social Security Number:_________________ Texas Driver's License No.: ________________

The Discovery School was recommended by:__________________________________________________
Are parents living together, separated or divorced:_____________________________________________
If separated or divorced, who has custody of the child:_________________________________________
Please list home address and phone number of other parent:______________________________________
___________________________________________________________________________________
Hours of enrollment (please note the hours of drop off and pick up and if you will need after school care):
___________________________________________________________________________________
___________________________________________________________________________________

In case of an emergency and parents cannot be reached, please contact one of the following people:
Please list local friends and relatives:

Name:__________________________________
Address:__________________________________________ City:________________ Zip Code:______
Phone: Work:________________________ Home:______________________

Does your child have any medical problems we should be aware of? (i.e. allergies to food or insects, hay fever,
asthma, existing illnesses, previous serious illness or injuries, hospitalizations during the past 12 months or any
medications prescribed for long term, continuous illness, etc..)

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

What arrangements have you made for child care when your child is ill and you are unable to leave work at any
particular time?

___________________________________________________________________________________

Since we will spend a considerable amount of time with your child during the week, we feel it is important to
know as much about him/her as possible. This is especially helpful to the teacher during the first few weeks
of school. The teacher can utilize this information in making the child's adjustment easier. This is also important
when the child is feeling ill or just homesick. Please tell us about your child likes, dislikes, habits, favorite stuffed
animals, or any other pertinent information that might help make the transition to our school a little easier.

Siblings: Name ______________________ Age: ________

PARENT CONFERENCES AND PARENTAL INVOLVEMENT

Parent/Teacher conferences will be held every nine weeks to review your child's learning portfolio. Parental
involvement is essential to our school and to the quality of your child's education so we ask that you take an
active role in our school. We would love to have you donate any special skills or talents with us. We will have
monthly parent group meetings in the evenings as well as many other ways to become involved in our school.
We will be sending different forms of communication home every day and we encourage parents to spend as
much time as they can at our school.

AUTHORIZATION FORMS

AUTHORIZATION FOR THE RELEASE OF YOUR CHILD

When my child, _____________, is brought to The Discovery School or Children's Discovery Center, I agree to
always leave him/her with a staff member and acknowledge the arrival with that staff member ( do not let your
child in the gate and leave without talking to a staff member ). The child shall only be released to the parents or
people listed in the space below. I agree to notify the center if anyone other than these people will be picking up
my child.

Names of friends or relatives allowed to pick up my child when in the care of The Discovery School or Children's
Discovery Center:

___________________________________________________________________________________
___________________________________________________________________________________

AUTHORIZATION TO LEAVE FACILITY

I hereby give my consent for my child, _________________, to leave The Discovery School or Children's Discovery
Center to participate in field trips that are announced in advance, and require my signature for permission.

AUTHORIZATION FOR NEIGHBORHOOD ADVENTURES

I hereby give my consent for my child, _________________, to participate in supervised walks in and around the Hyde
Park neighborhood and to nearby facilities (such as Shipe Park and Elizabet Ney Museum) as well as the White Cliff
neighborhood and nearby creeks and parks (such as Bull Creek).

HEALTH STATEMENT

My child, ____________________, has been examined by a licensed physician within the past year or has been examined
in a clinic or is enrolled in an on-going health program. My child is physically able to take part in the program provided by
The Discovery School or Children's Discovery Center. My child will continue to receive required immunizations while enrolled in this facility and agree to submit all immunization records to the Director for photocopying PRIOR to enrollment realize that I may not be permitted to enroll without immunization records. The date of his/her last physical examination:

___________________________________________________________________

EMERGENCY MEDICAL AUTHORIZATION

In the event I cannot be reached to make arrangements for emergency medical treatment for my child: _________________, I hereby authorize any staff member of The Discovery School or Children's Discovery Center or other capable adult or emergency medical attendant to transport my child to the nearest medical facility and request any necessary medical treatment in the event of an emergency. I request that he/she is taken to the following medical centers, if possible, for treatment: ____________________________________________________________________.

Physician's Name:_________________________________ Telephone: _____________________
Address:________________________________________________
The hospital or emergency facility I prefer is:
Name:_________________________________________ Telephone:________________

Signature of Parent or Guardian: ___________________________________Date:__________

I agree to provide a current record of immunizations for my child to the director of The Discovery School or The Children's
Discovery Center PRIOR to the first day of enrollment, along with this completed application. I also agree to follow the
immunization schedule as required by the Department of Human Services as outlined in the Parent Handbook.

I understand The Discovery School observes the AISD calendar for holidays and teacher in-service days. I understand
that tuition is not prorated for these holidays and teacher in-service days.

I agree to provide all necessary documentation as required by the Department of Human Services prior to my child's
enrollment.

I understand that upon withdrawal of my child from The Discovery School or The Children's Discovery Center, a thirty day,
written notice must given to the Director. I understand that if this notice is not given, I forfeit my enrolment deposit.

I understand when I sign below that I am acknowledging the policies stated within this document and I agree to abide
by them for so long as my child is enrolled in The Discovery School or Children's Discovery Center.

Signature of Parent or Guardian: ________________________________________ Date:________