THE LEARNING STATION PRESCHOOL
3908 Turner Avenue
Plano, IL 60545
(630) 552-9097

To register, please mail registration form along with your $75.00 non-refundable registration fee to the address listed above.  If you would like to view our school, please contact us at (630) 552-9097.

                   STUDENT REGISTRATION FORM

Child's name:_____________________________________D.O.B._________Sex:_____

Home Address: ___________________________________________________________

Telephone Number:_________________________________

Program: Thrilling Threes A.M._____ or P.M._____

Fabulous Fours A.M._____ or P.M._____

FATHER or GUARDIAN'S NAME: _______________________________________

Home Address: (if different than child's)_______________________________________

Home Telephone: (if different from child's)____________________________________

Work Telephone:_____________________ Cell Phone:__________________________

Employer Name and Address:_______________________________________________


MOTHER or GUARDIAN'S NAME:________________________________________

Home Address: (if different than child's)_______________________________________

Home Telephone: (if different from child's)____________________________________

Work Telephone:_____________________

Cell Phone:__________________________

Employer Name and Address:_______________________________________________


EMERGENCY CONTACT (other than parent/guardian)…please include name, relationship, address and telephone number:

1. _________________________________________________________________
2. _________________________________________________________________



AUTHORIZED PERSONS TO PICK UP CHILD (other than parent/guardian):

1.________________________________________________________________
2.________________________________________________________________

LIST ANY MEDICAL ISSUES (allergies, asthma, etc.):

1._________________________________________________________________
2._________________________________________________________________

Child's Physician:_________________________ Telephone:_________________

Address:____________________________________________________________


FIELDTRIP PERMISSION:

I/we give The Learning Station Preschool permission to take my child on walking trips on the premises. I/we understand that all walks are supervised under the above name and that all precautions will be taken for the child's safety. All other fieldtrips will require a separate signed permission slip distributed by the staff prior to the event.

Date:______________Signature:________________________________________