FAIRMONT PRIVATE SCHOOL APPLICATION

New Fall/Spring Student Registration Form

Please complete the form below to enroll your child into Fairmont Private School.

  • * (mandatory fields)

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    1. CHILD'S INFORMATION

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    Male     Female

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    Returning Student
    New Fall/Spring Student

  • 2. FALL/SPRING CLASS AND SCHEDULE

    Select Class:

     Toddler
     Brave Bears (3 yrs)
     Preschool (3.5 yrs-4.5yrs)
     Transitional Kindergarten
     Kindergarten
     First Grade

    Select Schedule:

     Monday through Friday(5 days)
     Tuesday and Thursday
     Monday Wednesday Friday
     8:30-12:00  12:00-3:30  8:30-3:30

    Select Additional Programs

     Early Arrival Care before 8:30 - (7:00-8:30)
     Lunch Hour Option for Preschool/Kindergarten - (12:00-1:00)
     Afterschool Care - (3:30-5:30)
     Bus Pick Up/PM Kindergarten/Afterschool Care (5 days) - (1:00-5:30)
     Bus Pick Up/PM 1st Grade/Afterschool Care (5 days) - (3:00-5:30)

  • 3. FAMILY INFORMATION



    First


    Last



    Street Address


    Address Line 2


    City


    State


    Zip / Postal Code






        Check if Parent 2 address is the same as parent 1.



    First


    Last



    Street Address


    Address Line 2


    City


    State


    Zip / Postal Code






  • 4. CONSENT FOR EMERGENCY MEDICAL TREATMENT: (LIC 627)

    AS THE PARENT OR AUTHORIZED REPRESENTATIVE, HEREBY GIVEN CONSENT TO FAIRMONT PRIVATE SCHOOL OF FRESNO TO OBTAIN ALL EMERGENCY MEDICAL OR DENTAL CARE PRESCRIBED BY A DULY LICENSED PHYSICIAN (M.D.) OSTEOPATH (D.O.) OR DENTIST (D.D.S.) FOR:     THIS CARE MAY BE GIVEN UNDER WHATEVER CONDITIONS ARE NECESSARY TO PRESERVE THE LIFE, LIMB, OR WELL BEING OF THE CHILD NAMED ABOVE.



  • 5. INSURANCE INFORMATION






  • 6. ALLERGIES


    Mild     Moderate     Severe




  • 7. EMERGENCY CONTACTS AND PERMISSION TO PICK UP CHILD





































  • 8. RELEASE

    Permission to Use Photograph or Video
    I grant Fairmont Private School the right to take photographs of my family and child in connection with school events. I agree that Fairmont Private School may use such photographs of my family and child for advertising and Fairmont's website. I have read and understand the above.




    Permission to Release Address and Phone Information to Only Other Fairmont Families
    I grant Fairmont Private School the right to release my phone and address information to other Fairmont families for purposes of coordinating school events, birthday parties, and play dates. I have read and understand the above.