Campus Kids at Miami University Hamilton

Application Procedure: Registration Form
for Preschool Program (3-6 years)

Note: All fields are required.
Today's Date:

Please confirm Preschool Program resgistration:		Yes, I wish to register for the Preschool Program (3-6 yrs.)

Name of Child(ren):

Date of Birth for Child(ren):

Name of Parent/Guardian:

Parent's Phone Number:

Parent's email address:

Parent's Address:

Days/times child(ren) will be at Campus Kids:

Please check day(s):		Please indicate time(s):
	Monday

	Tuesday

	Wednesday

	Thursday

	Friday



Registration Fees: $30 for child(ren) of student $35 for child(ren) of faculty/staff members. NOTE: Fees are subject to change. Registration fee is due when the parent accepts the childcare slot.


1. I understand that Campus Kids is a child care center licensed by the State of Ohio Department of Human Services and operated by Miami University.

2. I agree to pay the registration fee and promptly pay my fees to the Business Office in Mosler Hall. (Checks are made payable to Miami University indicate "Child Care" on the check.) I agree to give the Director two weeks written notice of withdrawal or change of billing. I understand that payment is due whether or not my child is present at the center on his or her scheduled days and /or times.

3. I agree to furnish all forms necessary for proper registration of my child, including all medical and emergency information, medical records statement, liability forms, and a copy of my class schedule, if applicable.

4. I do/ do not want my name on a roster for general distribution to other Campus Kids parents and workers.





For Office Use Only:
Social Security #