*Students First Name

*Student Gender

*Students Last Name

*Students Birth Date(Must be 4 years old by Aug 1, 2026 / Enter date MM/DD/YYYY)

*Parent/Guardians First Name

*Parent/Guardians Last Name

*Mailing Address

*City

*State

*ZipCode

*Cell

Work

*Parent/Guardians Email

Emergency Contact Information

*Adult First Name

*Adult Last Name

*Relation to the Student

*AdultsCell

Adults Work

Alternative Contact

*Alternative First Name

*Alternative Last Name

*Relation to the Student

*Alternative Cell

Alternative Work

*Please list all your child’s allergies

*If an emergency occurs, do we have your permission to take your child to the hospital?

Yes

Doctor’s Name

Doctors Phone

Preferred Hospital/Clinic

Commitment to Participation & Education

I commit to attending Parent Orientation & Meet-the-Teacher on Monday, September 1, 2026, to understand the program’s goals, rules, and expectations. If I am unable to attend, I agree to meet promptly with NDUEC administrators upon registration to review this information.

I commit to attending at least two of the four Family Support Nights because my participation is essential to showing my child/children the importance of their education. Failure to attend may result in a required meeting with NDUEC staff to review family engagement expectations and develop a plan to support student success.

I commit to maintaining open communication with NDUEC staff and the school, recognizing that a robust partnership significantly enhances my child(ren)s learning, development, and well-being.

I commit to ensuring that my child/children have no more than twelve absences during the academic year. Should my child/children be unable to attend, I will notify the NDUEC staff by noon on the day of their absence.

I recognize that my child/childrens behavior, cooperation, and willingness to participate are vital to their academic success.

I acknowledge that I have received and read the Notre Dame Urban Education Center (NDUEC) Handbook. I understand and agree to comply with the policies, procedures, and expectations outlined in the handbook.

I understand that my child’s behavior, cooperation, and willingness to participate in the program are essential for their academic success. My child is expected to utilize an assignment notebook.

Registration Fee

I commit to paying the registration fee as part of the enrollment process and acknowledge it as an investment in my child/childrens education. I further understand that the registration fee is non-refundable.

To complete the enrollment process, I agree to pay the registration fee by

Parent/Guardian Authorization

Please check appropriate parent/guardian authorizations.

*If the persons listed above, or I cannot be reached in an emergency, I authorize the attending physician to administer proper and necessary treatment for the safety of my child.

Yes

I grant permission to Notre Dame Urban Education Center (NDUEC) to photograph, videotape, and record my child during participation in NDUEC programs and activities. I authorize NDUEC to use these images and recordings for educational, promotional, fundraising, marketing, and public relations purposes, including print, website, social media, and other communications. I understand that no compensation will be provided and that this permission remains in effect unless revoked in writing. Any revocation will apply only to future use and not to materials already published.

Yes

I authorize my child to be picked up

*by:

*Relationship to the Student

In the event that neither I nor the alternate contact listed above can be reached in an emergency, I authorize the attending physician to administer proper and necessary treatment for the safety of my child.

*Parent/Guardian signature

*Print Parent/Guardian signature

*Date

Early Learning Registration

Registration