3 Day 4s (T-W-TH) Registration |

Registering for the 3 day T-W-TH 4 & 5 year old class

Student Information

Child Name *

First

Last

Child's DOB *

Child's Gender *

Female
Male

Nickname

What name would you like us to call your child by *

What name would you like us to teach your child to write *

# of Children in Family *

Child's Position in Family *

Are you entering the lottery for UPK? *

Yes
No
Maybe

Allergies, Classifications, Conditions, Dietary Restrictions, None *

Parent/Guardian 1 Information

Parent 1 Name *

First

Last

Parent 1 Email *

Parent 1 Cell *

Parent 1 Full Address (street, city, state and zip) *

Parent 1 Occupation *

Parent 1 Work Phone *

Parent/Guardian 2 Information

Parent 2 Name

First

Last

Parent 2 Email

Parent 2 Cell

Parent 2 Full Address (street, city, state and zip)

Parent 2 Occupation

Parent 2 Work Phone

Emergency Contact & Medicial Information

Primary Person to call during SCHOOL HOURS if needed *

First

Last

Phone # of Primary Person to call during SCHOOL HOURS if needed *

Emergency Contact Name *

First

Last

In case of an emergency and YOU CANNOT be reached this person will be called

Emergency Contact Phone # *

In case of an emergency and YOU CANNOT be reached this person will be called

Child's Physician (name) *

Name of Practice *

Physician's Phone Number *

Persons Authorized to Pick Up Your Child (Other than Parent/Guardian)

Authorized Person 1

First

Last

Authorized Person 1 Phone Number

Authorized Person 1 Relationship to Child

Grandparent, Aunt/Uncle, Nanny, etc.

Authorized Person 2

First

Last

Authorized Person 2 Phone Number

Authorized Person 2 Relationship to Child

Grandparent, Aunt/Uncle, Nanny, etc.

General Information

Class Size Disclaimer

Health Information

I understand that I must submit a current (dated 2026) copy of my child’s Immunization Record prior to the first day of school. I will also submit a new copy of this record if my child has a birthday and a well child visit during the school year.

Health Information *

By checking this box you have read, understand and agree to Health Information

Medical Agreement

In the event of an emergency, every effort will be made to contact the parent. In the event that I cannot be reached, I authorize Gateway Fairport Nursery to act on my behalf. I understand that they will use their best judgement and if the emergency requires medial care, I give Gateway Fairport Permission to call 911 on my child’s behalf and I accept and understand that I am responsible for any and all medical costs that may incur. In the event of minor injuries at Gateway Fairport, I give permission to the staff to administer any basic first aid needed (washing injury, band-aid, ice pack).

Medical Agreement *

By checking this box you have read, understand and agree to Medical Agreement

Photo Consent

I give Gateway Fairport permission to take photos of my child throughout their preschool day and share via weekly newsletter. If there is a photo of your child that Gateway Fairport would like to use on their Facebook page or on their website - they will ask for your permission.

Photo Consent *

By checking this box you have read, understand and agree to Photo Consent

Information Consent

I give Gateway Fairport permission to share my child’s contact information (name, parent’s name, address, phone numbers, emails) in the form of a Friendship List to the other families in the class.

Information Consent *

By checking this box you have read, understand and agree to Information Consent

Gateway Handbook

I have reviewed the Gateway Handbook located on the website (gatewayfairport.com). If I need a physical copy of the handbook, I will reach out to the Owner/Director for a physical copy. I agree to notify Gateway Fairport Nursery in writing of any changes in family status, address, and or emergency contacts.

Gateway Handbook *

By checking this box you have read, understand and agree to Gateway Handbook

Important Tuition Dates

* First quarter of tuition (September, October, November) tuition will be due on June 1st. Failure to pay by July 1st. Will forfeit your child’s spot at Gateway. This first quarter tuition will only be refunded if the child is moving out of the area or because of a medical condition.

* Remainder of tuition payments will be due the 15th of the month starting in November
and ending on April 15th (even though the program will go into May).

* A LATE FEE of $15.00 will be charged if tuition payments are not received by the 15th of the month.

* Checks returned due to NSF will result in a charge that is determined by the bank.

* Venmo is accepted @GatewayFairport. Parents are responsible to pay a $5.00 service fee per class tuition that you are paying for. (For example if you have 2 children in classes, you must pay their tuition and an additional $10 to cover Venmo Fees).

* A 30 day written notice is required to withdraw from the program.

Important Tuition Dates *

By checking this box you have read, understand and agree to Important Tuition Dates

Registration & Payment

A non-refundable registration fee of $100 is due at the time of online enrollment. Enrollment forms must be submitted at the time of Registration (this registration is the electronic enrollment form). Immunization forms are to be turned in no later than at the Meet and Greet.