IFP Registration Form - Ithaca Forest Preschool

Parent Name (Account Holder) *

Full Name

Email Address *

Phone Number *

XXX-XXX-XXXX

Secondary Phone #

XXX-XXX-XXXX

When are the best times to contact you?

Our office hours are M-F, 9am-4:30pm

Participant's Full Name *

Full Name

Participant prefers to be called (if applicable):

Participant's Gender *

Female

Male

Other

The participant is my child / step child *

Yes

No, we have a different relationship (i.e., grandchild, etc)

Participant Birth Date *

DD/MM/YYYY

Mailing Address *

Mailing Address

City

State/Province

Zip/Postal

How did you hear about Ithaca Forest Preschool? *

i.e. friends, Internet search, flyer, etc.

Which session(s) are you interested in registering for Ithaca Forest Preschool? *

Registration for Full Year and Fall + Winter opens on April 5. Registration for Fall Only and Fall + Spring opens on April 15.

Which days are you interested in?

Monday - Friday (5 days)

Monday, Wednesday, Friday (3 days)

Tuesday & Thursday (2 days)

Which payment option works best for your family? *

Full payment by the due date(s)

For full year participants only - 3 proportional payments at the trimester due dates

For full year participants only - Multiple automatic payments from a debit or credit card

Please see our website for more information on payment options

Financial assistance is available. Do you plan to apply for a scholarship?

Yes

No

Forest Preschool Support Questions:

What, if any, experience does your child have with non-family caregivers or structured programs (for example child care, preschool, camps)? *

Has your child had any prior special needs? Has your child ever had an IFSP (Individual Family Service Plan) or IEP (Individual Education Plan)? If so, would you be willing to share those documents with us so we can better understand how to support your child? How do you think the issues your child was assessed for might impact them at Forest Preschool? *

How is your child doing with potty training? Are you confident they will need only minimal assistance by the time school starts? What kind of assistance do you anticipate they might need, especially given we are outdoors and the child will often be wearing a lot of layers of clothing? *

Do you know if your child already knows any other Ithaca Forest Preschool students or instructors? (If yes, who?) *

Is there anything else you want to tell us about your child’s needs while with us? How can we best support your child’s transition to Forest Preschool? *

Please list any recent/current illness/injury (please provide dates); Existing medical conditions; Restrictions/limitations; Special needs/diets; Allergies (eg. medications, food, insect stings); Other Concerns or Conditions: *

If none, type "NONE"

Medications that will be brought to the program: *

If none, type "NONE"

Physician's Name *

Type NONE if you have not secured a physician for your preschooler yet

Tick Removal: Minimizing the risk associated with tick bites requires quick detection and prompt removal of embedded ticks. Do you give consent for trained staff to remove an embedded tick found on exposed skin of the participant during the program? In the event that this should happen, we will inform you at or before pick-up time, and will provide you with as much information about the tick and the bite as possible. *

No

Yes

For more information, please see our Frequently Asked Question: What about ticks? (https://ithacaforestpreschool.org/frequently-asked/)

Photo Authorization: Do you give permission for the participant’s likeness, in photo or video, to be used for Primitive Pursuits or Cornell Cooperative Extension promotional/educational media? *

No

Yes

Participant Demographic Information

As a program of 4-H Youth Development, we are required to collect the following demographic information:

Residence *

Ethnicity *

Hispanic

Non-Hispanic

Would you like to be added to our email lists?

Forest Preschool Interest

General Interest

Summer Camp Interest

No, thank you

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Start the Registration Process

Forest Preschool Support Questions:

Participant Demographic Information