Gender *
Select… Male Female
Phone number *
Phone type Mobile Home Work Other
Which Day(s) would you prefer your child to attend? *
Please select the days you would like your child to attend.
Select… Monday/Wednesday Tuesday/Thursday
Would you be able to switch from preferred days? *
(If your preferred days are full, would you be okay with switching to the other days available days?)
Select… Yes No
Potty trained? *
Your child must be fully potty trained for PreK and Jr. Kindergarten
Select… Yes No Working on it
Any allergies?
Please list and note the severity
Other information
Please share with us any information that can help us best meet your child's needs while under our care
Parents information *
Please list parents first and last name along with the best contact phone number and email address
Emergency Contact *
Please list any Emergency Contacts by name, phone number and relationship to child (this is in the case we are unable to reach the parents)
Alternate Pickup *
Please list other persons whom you approve to pickup your child
Medical Release *
I grant to Hixson Presbyterian Church, its representatives and employees, permission to seek medical attention for my child(ren) if necessary while participating in any event sponsored by the church. I understand that necessary precautions will be taken for my child's safety. I will not hold the church, staff, or those supervising liable.
Select… Yes No
Classroom Photo Use *
I grant to Hixson Presbyterian Church, its representatives and employees, the right to take photographs of my child(ren) and property while participating in any event sponsored by the church for USE IN THE CLASSROOM. Examples include classroom crafts and bulletin board displays. Please use the drop down below to indicate if you DO or DO NOT give permission for CLASSROOM USE of photos.
Select… Yes, I DO give permission No, I DO NOT give permission
Photo/Video Permission *
I grant to Hixson Presbyterian Church, its representatives and employees, the right to take photographs of my child(ren) and property while participating in any event sponsored by the church for PROMOTIONAL USE.I authorize HPC, its assigns and transferees to publish the same in print and/or electronically. Examples include promotional brochures, website, social media. Please use the drop down below to indicate if you DO or DO NOT give permission for PROMOTIONAL USE of photos.
Select… Yes, I DO give my permission No, I DO NOT give my permission
Code of Conduct
At the beginning of each school year, children will be taught the Code of Conduct. Parents will be asked to sign this code to promise to support our efforts in requiring their child to respect and abide by the Code of Conduct. By signing this registration form you are agreeing to the code of conduct. All children will have the Code of Conduct reinforced throughout the year by their teacher in an age-appropriate manner.
Covid Waiver *
COVID WAIVER: By registering for an event with Little Seekers Day School at Hixson Presbyterian Church, you acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you and your family may be exposed to or infected by COVID-19. You also acknowledge that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of yourself and/or others, including, but not limited to, LSDS employees, HPC employees, volunteers, and participants and their families. You agree to assume all the foregoing risks, waive liability against the Little Seekers Day School at Hixson Presbyterian Church and any other listed parties, and accept sole responsibility for any illness, injury, disability, or death to you or your family, including all claims that may arise resulting from any of these. By writing my name I understand all of what I have read above.
By checking this box I understand I have read the Parent Handbook located on the website.
Signature/Date *
By writing my name below I affirm that I have read and understood the above permissions
Submit