Pebbles Preschool & Kindergarten

Child Information
Child's Full Legal Name:*
First Middle Last
Child's Date of Birth:*
Child's Sex:*
- Male
- Female
Child's Current Address of Residence:*
Street Address Address Line 2 City State ZIP Code
Child's Class:*
- Toddler (1-2)
- Preschool (3-4)
- Kindergarten
Child's Status:*
- New Student
- Returning Student
Extended Care:
The Pebbles school day hours are 9:00AM - 2:00PM. Pebbles offers an Extended Care program from 7:00AM - 9:00AM and 2:00PM - 6:00PM for an additional tuition price.
- Yes, I will need to enroll my child in the Extended Care hours.
- No, I do not currently need the Extended Care option.
I will be enrolling my child in:
- Up to 2 hours per day of Extended Care
- Up to 4 hours per day of Extended Care
- Up to 6 hours per day of Extended Care
Enrollment Schedule
Pebbles offers class schedules on 2, 3, and 5 day-per week schedules. These days are set and nontransferable/nonnegotiable. Please select your class enrollment schedule below:
- 2 Days per Week: Tuesday and Thursday
- 3 Days per Week: Monday, Wednesday, and Friday
- 5 Days per Week: Monday through Friday
Intended Start Date:

(The first day you expect your child to attend Pebbles)

Upload Child's Photo
For security purposes, it is beneficial to both our organization and our enrolled children to maintain current records of our students. A photo of your child can be extremely helpful in ensuring that we maintain proper, individualized care according to your instructions (i.e. allergy, nutrition, pickup procedures, etc.). Having updated photos also ensures that we are able to provide full security and safety measures if necessary. These photos are for documentation purposes only and will not be shared or displayed with any unauthorized individual. This is entirely optional, and your participation or lack thereof does not in any way affect, sway, or decide the enrollment process.
Accepted file types: jpg, gif, png.

Family Information
Parents are:*
Custody of the child is with:*
Father's Name:
First Last
Father's Email Address:
Father's Phone Number:
Mother's Name:
First Last
Mother's Email Address:
Mother's Phone Number:
Does either parent live in a place of residence separate from the child?
- Mother
- Father
(Check all that apply)
Father's Current Address of Residence:
Street Address Address Line 2 City State ZIP Code
Mother's Current Address of Residence:
Street Address Address Line 2 City State ZIP Code
Does this child currently have any siblings attending Pebbles?
- Yes
- No
Sibling Name(s):

Emergency Contact List
The Pebbles staff is authorized to contact the people (in numerical order) listed on the Emergency Contact List in the case of an emergency if parents cannot be reached.

Inclusion on the Emergency Contact List also authorizes Pebbles to release your child from their class at Pebbles to an emergency contact. These individuals are in addition to the parents/guardians listed earlier in the application. Priority of contact will always be made with the parents/guardians first.
Emergency Contact 1 - Name:*
First Last
Emergency Contact 1 - Phone:*
Emergency Contact 1 - Address:*
Street Address Address Line 2 City State ZIP Code
Emergency Contact 1 - Relationship to Child:*
Emergency Contact 2 - Name:*
First Last
Emergency Contact 2 - Phone:*
Emergency Contact 2 - Address:*
Street Address Address Line 2 City State ZIP Code
Emergency Contact 2 - Relationship to Child:*
Emergency Contact 3 - Name:*
First Last
Emergency Contact 3 - Phone:*
Emergency Contact 3 - Address:*
Street Address Address Line 2 City State ZIP Code
Emergency Contact 3 - Relationship to Child:*
In the case that either of my child's parents cannot be reached during an emergency, I authorize Pebbles Preschool & Kindergarten to contact any of the people above on the Emergency Contact List and defer to their guidance. I also grant permission for Pebbles Preschool & Kindergarten to release my child into the care of any of the individuals on the Emergency Contact List should neither of my child's parents be available for timely pick up.*

Medical Information
Doctor to contact in case of emergency:
First Last
Doctor Phone Number:
Doctor Address:
Street Address Address Line 2 City State ZIP Code
Existing Illnesses:
If no existing illnesses, type "None".
Previous Serious Illnesses or Injuries:
If no previous serious illnesses or injuries, type "None".
Medication Prescribed for Long Term Use:
If no prescribed medication, type "None".
Special Medical Instructions:
If no special instructions, type "None".
Allergies:
If no allergies, type "None".

Medical Authorization
In the unlikely case medical attention is needed for my child and neither parent can be reached by phone, I authorize Pebbles staff to take whatever emergency medical measures deemed necessary for the protection of my child while he/she is in their care. I understand that this authorization may include calling the aforementioned physician and implementing his instructions. I will not hold Pebbles or its staff liable for any accident or injury to the child while he/she is at Pebbles, provided any such accident or injury is not caused by the staff's negligence or willful acts.
Signature:*
By digitally signing my name above, I accept the terms of the Parental Authorization for Medical Care.

Photo/Film Release
Throughout the school year and/or summer programs, your child and his/her work WILL BE photographed/filmed for (but not limited to) our annual scrapbooks, crafts/activities, slideshows, and portfolios.

We also frequently showcase children’s activity and work online via the Pebbles website (www.pebbleskids.org) and/or Pebbles social media accounts, as well as in external marketing campaigns (web ads, print work, brochures, etc.). This additional showcase is on a voluntary basis, and children will only be featured in this capacity with parental/guardian authorization.
Please check the applicable statement:
- Photos and/or video of my child and/or my child’s work MAY appear on the Pebbles website, social networks, and/or external marketing campaigns.
- Photos and/or video of my child and/or my child’s work MAY NOT appear on the Pebbles website, social networks, and/or external marketing campaigns.

Nutrition Statement
Throughout the school year and summer programs, you have agreed to supply non-refrigerated and non-heated lunches for your child on a daily basis. By accepting the terms below, you understand that Pebbles is not responsible for the nutritional value of your child's intake or for meeting your child's daily food needs.
Signature:*
By digitally signing my name above, I accept the terms of the Nutrition Statement.

Water Play Activity Release
I hereby authorize Pebbles Preschool and Kindergarten to include my child in supervised water play activities.
Signature:*
By digitally signing my name above, I accept the terms of the Water Play Activity Release.

Discipline Guidelines
Per the Minimum Standards of the Texas Department of Protective and Regulatory Services:
Rule 746.2801
To what extent may caregivers discipline the children in the care?
Discipline must be individualized and consistent for each child; appropriate to the child's level of understanding; and directed toward teaching the child acceptable behavior and self-control.
Rule 746.2803
What methods of discipline and guidance may a caregiver use?
A caregiver may only use positive methods of discipline and guidance that encourage self-esteem, self-control, and self-direction, which includes at least the following: Using praise and encouragement of good behavior instead of focusing only upon unacceptable behavior; Reminding a child of behavior expectations daily by using clear, positive statements; Redirecting behavior using positive statements; and Using brief supervised separation or time out from the group, when appropriate for the child's age and development, which is limited to no more than one minute per year of the child's age.
Rule 746.2805
What types of discipline and guidance or punishment are prohibited?
There must be no harsh, cruel, or unusual treatment of any child. The following is prohibited: Corporal punishment or threats of corporal punishment; Punishment associated with food, naps, or toilet training; Pinching, shaking, or biting a child; Hitting a child with a hand or instrument; Putting anything in or on a child's mouth; Humiliating, ridiculing, rejecting, or yelling at a child; Subjecting a child to harsh, abusive, or profane language; Placing a child in a locked or dark room, bathroom, or closet with the door closed; and Requiring a child to remain silent or inactive for inappropriately long periods of time for the child's age.
Signature:*
By digitally signing my name above, I accept the terms of the Discipline Guidelines.

What's Next?
We are so thrilled you've chosen Pebbles for your child's education. After submitting the application below, we will quickly begin the review process, and will contact you in the next 24-48 hours with more information. Filling out this application does not automatically enroll your child in our program, and an annual $100 enrollment fee is required to hold your child's spot.
How did you hear about Pebbles?*
- Online Search
- Recommendation from friend/family
- Billboard
Email
This field is for validation purposes and should be left unchanged.

Pre-Enrollment

Application for Pre-Enrollment

Step 1 of 11

Child Information

Family Information

Emergency Contact List

Medical Information

Medical Authorization

Photo/Film Release

Nutrition Statement

Water Play Activity Release

Discipline Guidelines

What's Next?

About Us

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