Enroll

Thank you for your interest in enrolling at Excelsior Prep Preschool. We strive to make the enrollment process easy and effortless. With a few simple steps, you’ll be on your way to joining our school! Open registration is every day from 6:30 am – 6:30 pm. Spaces are limited.

Student Information
Date of Birth*
MM slash DD slash YYYY
Sex*
Date of Enrollment*
MM slash DD slash YYYY
First Name*
Middle Name*
Last Name*
Nick Name*
Address
Street Address Address Line 2 City State ZIP Code
Primary Hours of Care
From*

: Hours

Minutes

AM/PM
To*

: Hours

Minutes

AM/PM
Days of the Week in Care*
- Select All
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
- Sunday
Meals Typically Served While in Care*
- Select All
- Breakfast
- Morning Snack
- Lunch
- Afternoon Snack
- Supper
- Evening Snack
Family Information
Child Lives With*
Mother's Name*
Mother's Address*
Street Address Address Line 2 City State ZIP Code
Mother's Home Phone*
Mother's Employer*
Mother's Employer Address*
Street Address Address Line 2 City State ZIP Code
Mother's Work Phone*
Mother's Cell Phone*
Father's Name*
Father's Address*
Street Address Address Line 2 City State ZIP Code
Father's Home Phone*
Father's Employer*
Father's Employer Address*
Street Address Address Line 2 City State ZIP Code
Father's Work Phone*
Father's Cell Phone*
Custody*
Other Custody
Medical Information
I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.
Doctors
Doctor Name Address Phone
Hospital Preference
Please list allergies, special medical or dietary needs, or other areas of concern:
Contacts
Child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason, the custodial parent or legal guardian cannot be reached:
List of Contacts*
Name Address Work Phone Home Phone
Helpful Information About Your Child
- Section 65C-22.006(2), F.A.C., requires a current physical examination (Form 3040) and immunization record (Form 680 or 681) within 30 days of enrollment.
- Section 402.3125(5), F.S., requires that parents receive a copy of the Child Care Facility Brochure, "Know Your Child Care Facility” (CF/PI 175-24), or
  Section 65C-20.11(2)(c)(1), F.A.C., requires that parent(s) receive a copy of the family day care home brochure, “Selecting A Family Day Care Home Provider” (CF/PI 175-28).
- Section 65C-22.006(3)(c)2., F.A.C., requires that parents are notified in writing of the disciplinary practices used by the child care facility, or
  Section 65C-20.010(6)(c), F.A.C., requires that a written a copy of the family day care provider’s discipline policy be available for review by the parent(s).
Consent*
I give my consent to the following statement.
I agree that I have received the above items and that the information on this enrollment form is complete and accurate.
Date of Consent*
MM slash DD slash YYYY

We’d Love To Meet You

Do you have questions or would you like to arrange a tour? Please contact our Preschool Director, Ms. Heidy, at the school office (786) 542-0114.

Download An Enrollment Form

Doctor Name	Address	Phone

Name	Address	Work Phone	Home Phone

Student Information

Primary Hours of Care

Family Information

Medical Information

Contacts

We’d Love To Meet You