Skool Runner Enrollment Form-Skool Runner

Skool Runner Enrollment Form

First Name

Last Name

Phone Number

Address

Child(rens) Name

What school will your child(ren) be attending?

Ferguson

Thornton

What grade will your child(ren) be in?

Pre K

1st

2nd

3rd

4th

5th

6th

7th

8th

What date would you like service to begin? (First Day of School Starts August 8th)

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone

Does your child(ren) have any know allergies?

Yes (Please List Below)

Allergies:

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to the nearest medical facilty.

I give consent for the above mentioned facility to secure any and all necessary emergency medical care for my child.

I agree to the Parental Permission Statement

TUITION OPTIONS

I would like to enroll my child(ren) for the following services:

Single Student WEEKLY - $100 Per Week ($10 Per Trip)

Single Student MONTHLY Rate - $360 Per Month ($9 Per Trip)

Siblings (Two Students) WEEKLY - $180 Per Week ($18 Per Trip)

Siblings (Two Students) MONTHLY - $640 Per Month ($16 Per Trip)

I understand all MONTHY tuition payments will be set up on auto draft on the 1st of each month.

I understand all WEEKLY tuition payments will be due on Friday for the upcoming week.

By signing below, you acknowledge that a seat on Skool Runner will be held for my child for the upcoming school year.

Your Signature

Date