Sunflower Babies Enrollment - Sunflower Creative Arts

Parent One First Name

Parent One Last Name

Parent One Email

Parent One Phone

Parent One Occupation

Parent One Employer

Parent Two First Name

Parent Two Last Name

Parent Two Email

Parent Two Phone

Parent Two Occupation

Parent Two Employer

Home Address 1

Home Address 2

City

State

Zip Code

How many children are you enrolling?

One Child Two Children

First Child's First Name

First Child's Last Name

First Child's Gender

First Child's Birthday

Placement

I accept the placement I have been offered for child/ren above through the email I received from Sunflower.

I decline the placement offered to above child/ren.

If you have any questions, comments or concerns, Ashley, Susan or Ilysia would be happy to speak with you. You can get in touch with any of them by email [email protected] or calling 561 501-6615.

Persons to be contacted in case of illness, accident or emergency, if for some reason the parents or guardians cannot be reached, and authorized to remove the child from the facility.

Emergency Contact One NAME

(Other than parents)

Phone

Relationship

Emergency Contact Two NAME

(Other than parents)

Phone

Relationship

May we share your contact info (emails and phone numbers) with other parents in your class?

Yes No

Special Instructions regarding eating habits, toileting or areas of concern:

Child 1 - Allergies: (Select one of the options below)

My child DOES NOT HAVE any known allergies.

My child HAS allergies.

Permission for Application of Topical Lotions, Sprays and Ointments

I

give permission for Sunflower Creative Arts Staff to apply the following to my child/ren

Arnica is a Homeopathic Remedy For Pain, Bruising & Swelling.

Notes:

Permission for Administration of Oral Arnica and Benadryl

I

give permission for Sunflower Creative Arts Staff to administer the following to my child/ren,

Arnica is a Homeopathic Remedy For Pain, Bruising & Swelling.

Oral Arnica

Liquid Benadryl

None

Notes:

Sunflower Creative Arts Photo/Video Release

I/We hereby give to Sunflower Creative Arts, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents and employees, the right to reproduce in any of its printed and online publications (such as newsletters, annual reports, websites, social media posts and blog posts), as well as any media that has yet to be created, all pictures, audio and video that it has produced of myself and/or my child(ren).

I/we authorize Sunflower Creative Arts to use all such pictures, audio and video and duplicates thereof, in perpetuity, for its publicity purposes and dispose of them as they may see fit. I/we hereby release Sunflower Creative Arts, from all claims of every kind on account of such use.

Questions should be directed to Sunflower Communications Director, Jaime Greenberg, at [email protected] or 561 501-6615.

Photo Permission

Yes, to photos No, to photos

In consideration of Sunflower Creative Arts' acceptance of my child/ren's enrollment in this program, I hereby release all claims of damages to same.

Parent One Signature

Parent Two Signature

Babies Enrollment

Sunflower Enews

Success!