Nursery School Registration form


St Therese Nursery School Registration 2020 / 2021


Please List Two Emergency Names

The above listed emergency contacts have my permission to pick up my child from school.

The state of Connecticut mandates all children entering or attending preschool must have a physical examination/record form of not more than one year be kept on file of the attending preschool. Children will not be allowed to attend without this form.

Class Preference for 2020/2021


1. Please select in numerical order your class for your child for the next school year.

2. Please be aware that the classes are filled in the order that the registrations are received.

Three Year Old Program Choices

1. A.M. Session Tuesday & Thursday 9:00 a.m. to 11:30 a.m.

2. A.M. Session Tuesday & Thursday 9:00 a.m. to 12:30 p.m.
(Students stay for lunch)

3. P.M. Session Tuesday & Thursday 12:30 p.m. to 3:00 p.m.
*If a.m. is full

4. All day 9:00 a.m. to 3:00 p.m.

Note: Type 1 for your first choice, 2 for your second choice, 3 for your third choice, etc.

Four Year Old Program

1. A.M. session Monday, Wednesday, Friday 9:00 a.m. to 12:00 p.m.

2. P.M. session Monday, Wednesday, Friday 12:00 p.m. to 3:00 p.m.
• If a.m. is full

3. Pre-K Monday, Wednesday, Friday 9:00 a.m. to 3:00 p.m.

Note: Type 1 for your first choice, 2 for your second choice, 3 for your third choice.

Five Day program: Monday through Friday/ Available for both three and four year olds.

a. 9:00 a.m. to 3:00 p.m.

b. 9:00 a.m. to 12:00 p.m.Note:

Type 1 for your first choice, 2 for your second choice.

Dear Family,
The Office of Early Childhood Education has made a modification to their statutes with regards to children who under three upon the start of nursery school. Please sign and return to form below. If you have any questions, please feel free to contact me.
Michele Adinolfi

Parent/Director Authorization to Enroll Child Under 3 Into Preschool Program

Emergency Medical Permission

I give permission to St. Therese Nursery School staff to make whatever emergency (e.g. first aid, disaster evacuation) measures as judged necessary for the care and protection of my child while under the supervision of the school.
I give permission to St. Therese Nursery School staff (Director, teachers, and teacher assistants) to have access to my child’s health information.
If a serious illness or accident occurs during St. Therese Nursery School attendance, I give permission to the St. Therese Nursery School personnel to secure medical care from the most immediately available licensed medical personnel, at my personal expense.
In a medical emergency where more than first aid is to be applied, I understand that in this medical situation the staff will need to contact the local emergency resource before the parent, child’s physician, and/or the emergency phone contacts given by the parent.
In case of a medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit (police car, fire rescue vehicle, ambulance) if deemed necessary. The child will be transported at my personal expense. The child will be taken to an emergency hospital in the company of a staff member.

A copy of this emergency medical permission form will be placed in each student’s file located in the director’s office. This permission form and the child’s medical records will be transported with the child to the emergency hospital with the child.

St. Therese Nursery School Permission for a responsible adult (other than parent) to remove a child from the Program

St. Therese Nursery School Permission for Picture Publication

Dear Parents,
Throughout the year the staff will take pictures of the children during everyday play and special occasions. We also publish pictures in the North Haven Advisor or Citizen and in the vestibule of our church. Children will only be identified by their first name and last initial. Only children with parental permission will be published. Thank you for your assistance.
Miss Michele

REMIND Text Alert

Dear Family,
In order to distribute information quickly with regards to snow cancellations or other important reminders for our school, we now utilize a REMIND Text alert. Please sign below if you would like your cell phones (Mother and Father) to be included in this system. You will receive an initial text from REMIND asking for your permission to participate.
In addition, if you would like a grandparent or care provider to be added to this alert, please list their name and number below.
Miss Michele

I agree to have our cell phone numbers alerted for the REMIND text alert.

In addition, I would like the following people to be added to the REMIND text.

St. Therese Nursery School Telephone Book

Dear Parents,
Pre-school is the perfect opportunity to form new friendships! Finding a
common interest with a peer at school will lend itself to future play dates. We
would like to provide a school telephone book to assist you in setting up these play
dates. The telephone book will include a class list, your address for birthday
invites, your telephone number, and parent names. If you would like to give
permission for this information that will be distributed in the fall, please sign

Parent Handbook


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