www.funnfriends.com
Fun ‘n’ Friends Nursery School
973-584-0365   2010-2011

58 Drakedale Road

Flanders, NJ 07836

Child’s Name: ____________________________________________
Home phone: ________________________

Address____________________________________________Town______________________Zip_______________

Mother’s
Name__________________________Work Phone______________Cell
Phone_____________________

Father’s
Name___________________________Work Phone______________Cell
Phone_____________________

Family Status (please circle): Married,
Divorced, Separated, Widowed

Child’s Birth
Date___/____/____  Age as of
September 1, 2010_____Yrs.______Months….Gender: M  F

Father’s
Employer_______________________________Mother’s
Employer_________________________________

Contact person: Please list two (2)
people other than parents who would be available to pick-up your child.

Contact Name (1)
_______________________________________________________Relationship______________________

Home
Phone____________________________________ Cell
Phone_________________________________

Contact Name (2)
______________________________________________________Relationship______________________

Home
Phone____________________________________ Cell
Phone_________________________________

Person authorized in an emergency if
neither parent is available to assume responsibility for your child

Name:_____________________________________Phone
#_________________________Relationship_________________

Medical Information: Fun
‘n’ Friends
Nursery School is
authorized to transport my child to a medical facility and have my child
treated by a licensed physician in the event of an emergency.

Child’s Doctor________________________________________Doctor’s
Phone___________________________________

Registration: All Fun ‘n’ Friends classes have a
limited enrollment.  All
applications require a non-refundable registration fee ($65 for returning
families, $75 for new families) as well as a deposit of May’s tuition.  May’s deposit is 50% refundable
prior to December 31, 2010.  No
refund after January 1, 2011.  No adjustments will be made due to absences or
illness.  Fun ‘n’
Friends require a 30-day written notice prior to the effective date of any
withdrawal.  Any refunds due will be
prorated based on the effective date.

Tuition Payment Options (please select
one): For your convenience, Fun ‘n’ Friends offers two payment
options:

______Payment in Full: 5% discount for
tuition paid in full by September 1, 2010

______Monthly billing (8 installments): 1/8 of tuition balance payable monthly on the
first of the months September –April

Fun
‘n’ Friends
Nursery School offers a
sibling discount of 10% applied to all children after the first child enrolled
during the same school year and against the lesser of the tuition fees (excludes Kinder-Confidence).  Parent hereby gives permission to Fun
‘n’ Friends to photograph or video their son/daughter and to use
these pictures for brochures, websites, advertising
and/or display purposes.  Parents also
give permission to distribute to other school families the above information on
a class list.  All returned checks
and late payments are subject to a service fee.

Signature:_____________________________________________________________________Date:________________________

E-mail address: ____________________________________________________    Class: ___________