Early Learning Student Registration

*Student’s First Name

*Student’s Last Name

Student’s Birth Date

*Parent/Guardian’s First Name

*Parent/Guardian’s Last Name

*Mailing Address

*City

*State

*ZipCode

Parent/Guardian’s Phone Numbers:

*Cell

Work

*Parent/Guardian’s Email

Emergency Contact Information

*1st Contact First Name

*1st Contact Last Name

*Relation to the Student

*1st Contact’s Phone Numbers:

*1st Contact’s Cell

*1st Contact’s Work Number

*2nd Contact’s Phone Numbers:

*2nd Contact First Name

*2nd Contact Last Name

*Relation to the Student

*2nd Contact’s Cell

*2nd Contact’s Work

*Please list all your child’s allergies

*If an emergency occurs, do we have your permission to take your child to the hospital?

Yes

Doctor’s Name

Doctor’s Phone

Preferred Hospital/Clinic

Parent/Guardian Authorization

*My child will be picked up by

*Relationship to the Student

*Parent/Guardian signature

*Date

In the event that neither I nor the alternate contact listed above can be reached in an emergency, I authorize the attending physician to administer proper and necessary treatment for the safety of my child.

*Parent/Guardian signature

*Date

I authorize Notre Dame Urban Education Center to use photographs or video clips of my child and/or survey my child either through interviews or questionnaires for publicity purposes or data collection.

*Parent/Guardian signature

*Date

Early Learning Registration 2025 – 2026

Early Learning Student Registration

Emergency Contact Information

Parent/Guardian Authorization

The Sisters of Notre Dame

Our Center

Contact Info

Registration Packets/Resources