Enrollment Form

KIDazzle Child Care, Inc
Where Learning is Fun!!
KIDazzle Child Care & Learning Center Enrollment Application
Enrollment Package
Location of Service*
Application Date

MonthDayYear
Date
Sponsor Information:
Sponsor's Name:
Name

First NameLast Name
Sponsor Phone Cell Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsor Email
example@example.com
Sponsor Place of Employment/ Educational Program
Sponsor Address of Employment/ Educational Program
Sponsor Work Phone

Area CodePhone Number
Sponsor Day Time Phone Number

Area CodePhone Number
Co-Sponsor's Name:
Co- Sponsor Name

First NameLast Name
Co-Sponsor Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Co Sponsor Home Phone Number

Area CodePhone Number
Co Sponsor cell Phone Number

Area CodePhone Number
Sponsor Text to Cell

YesNo
Co Sponsor Text to Cell

YesNo
Co Sponsor emai
example@example.com
Co Sponsor Place of Employment/ Educational Program
Co Sponsor Address of Employment/ Educational Program
Business Co Sponsor Phone

Area CodePhone Number
Co- Sponsors Phone Number

Area CodePhone Number

Child's Medical Information:
Child's physician or clinic name:
Physicians Phone Number

Area CodePhone Number
My Child has the following special needs:
My child requires the following accommodations
My Child is currently on the following medication prescribed for long term use:
My child has the following allergies:
Parent/Guardian Signature:
Signature

Clear
Date

MonthDayYear
Date

Parental Agreement Form
Date

MonthDayYear
Date
.KIDazzle Child Care & Learning Center agrees to provide child care for the child listed below, beginning (That is provide above) (date) and continuing until written notification is provided by either party. The operating hours are 6:30 am – 6:00 pm, Monday – Friday. Consideration during Covid-19 KIDazzle Child Care's Hours will be hours 7:30am - 5:00p
Child's Name

First NameLast Name
2. I agree to pay all tuition fees per week for as long as the child is enrolled in the program. A two week notice must be given for withdrawal. I understand that no deduction will be made for holidays, inclement weather, or other times child is not in attendance at the center. A vacation credit is given for each six months the child is enrolled.

I also understand that the center closes at 6:00 PM (COVID-19 Hours). I will be charged a late fee of $2.00 per minute, payable before my child returns the following day.

Pre-K Only - I understand that there is no charge for tuition during the funded 6.5 hours of the instructional Pre-K day, 8:00 AM – 2:30 PM. A fee will be charged for Before and After Care for children in attendance outside the Pre-K hours.
Parental Agreement Form Program Type
Program Contribution: (This is if a family has an agency or third party paying a portion of the fees)
Sponsor Pay : (Amount that the family is responsible for weekly for this child)
Total weekly Tuition:
4. My child will participate in the following meal plan (circle applicable meals and snacks):

BreakfastLunchAfternoon SnackDinner (School age only)
5. I understand that KIDazzle does not dispense medication. Special permission must be given for any medication to be kept on site or dispensed (Epi Pen, Asthma treatment, Skin medication). If medication is kept on site I will provide a written authorization which includes: date, name of child; name of medication; prescription number; dosage; date and time of medication to be given. Medicine must be in the original container with child’s name on it.

6. My child will not be allowed to enter or leave the facility without being escorted by the parent(s), persons authorized by parents, or facility personnel. Child must be checked in/out on the computer daily and must be taken to their assigned classroom and placed in teachers care.

7. I acknowledge that I have been given a copy of the Safe Sleep Policy and a signed copy will be retained inmy child’s file.

8. I acknowledge it is my responsibility to keep my child's records current to reflect any significant changes as they occur, for example; telephone numbers, work locations, emergency contacts, child's physician, child's health status, and immunization records.

9. The facility agrees to keep me informed of any incidents including illnesses, injuries, adverse reactions to medicines, etc. which include my child. I authorize KIDazzle to obtain emergency medical care for my child if I am unavailable and the center deems necessary.

10. KIDazzle Child Care & Learning Center agrees to obtain written authorization from me before my child participates in routine walking or transportation, field trips, special activities away from the facility, and water related activities occurring in water that is more than two (2) feet deep.

11. I grant permission for my child to be included in evaluations and pictures connected with the school program.

12. I will not bring my child to the center with signs/symptoms of illness (Fever, rashes, pink eye, diarrhea, etc...) and agree to pick up, or arrange for the child to be picked up immediately if he/she becomes sick at the center. 13. A copy of the Parent Handbook, which contains the Health and Discipline policies is available on the KIDazzle website. I have been informed that if I cannot print a copy from the website a copy will be provided to me. I agree to abide by the policies and procedures for KIDazzle Child Care & Learning Center.

14. I understand that KIDazzle will advise me of my child’s progress and issues relating to my child’s care as well as any individual practices concerning my child’s special needs. I also understand that my participation is strongly encouraged in facility activities.
Signature

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Emergency Medical Authorization
Should (My CHild ) suffer an injury or illness while in the care of KIDazzle Child Care & Learning Center and the facility is unable to contact me (us) immediately, it shall be authorized to secure such medical attention and care for the child as may be necessary. I shall assume responsibility for payment of services. I agree to keep the facility informed of changes in telephone numbers, etc., where I can be reached. The facility agrees to keep me informed of any incidents requiring professional medical attention involving my child.
Child's Name

First NameLast Name
Child's primary source of health Care
Primary Care Physician Phone Number

Area CodePhone Number
Type a question
Signature

Clear

Safe Sleep Policy
Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Parent Name

First NameLast Name
1. Infants will be placed on their backs in a crib to sleep unless a physician’s written statement authorizing another sleep position for that infant is provided. The written statement must include how the infant shall be placed to sleep and a timeframe that the instructions are to be followed. In addition, the parent must provide a written and signed statement authorizing the modified sleep position.

2. Cribs shall be in compliance with CPCS and ASTM safety standards. They will be maintained in good repair and free from hazards.

3. No objects will be placed in or on the crib with an infant. This includes, but is not limited to, covers, blankets, toys, pillows, quilts, comforters, bumper pads, sheepskins, stuffed toys or any other soft items.

4. No objects shall be attached to a crib with a sleeping infant, such as, but not limited to, crib gyms, toys, mirrors and mobiles.

5. Only sleepers, sleep sacks, and wearable blankets provided by parents/guardians and that fit according to the commercial manufacturer’s guidelines and will not slip around the infants face may be worn for the comfort of the sleeping infant.

6. Individual crib bedding will be changed daily, or more often as needed, according to the rules.

7. Bedding for cots will be marked for individual use and laundered weekly or more frequently if needed.

8. Infants who arrive at the center asleep or fall asleep in other equipment, on the floor or elsewhere, will be moved immediately to a safety-approved crib for sleep.

9. Swaddling will not be permitted, unless a physician’s written statement authorizing the child to be swaddled is provided. The written statement must include instructions and a timeframe for swaddling the infant. In addition, the parent must provide a written and signed statement authorizing the practice of swaddling.

10. Wedges and other infant positioning devices and monitors will not be permitted unless a physician’s statement authorizing its use for the child is provided. The written statement must include instructions on how to use the device and a time frame for using it. In addition, the parent must provide a written and signed statement authorizing the use of the device.

I acknowledge that I have been advised of the safe sleep practices followed by the facility. If I have any questions please call the owners,

Michele Hill at 404-213-4426

Ben Hill 404-259-6630

Robert Hill 404-312-2918
Signature Infant Safe Sleep Policy

Clear

	Yes	No
Service Quality
Cleanliness
Responsiveness
Friendliness

KIDazzle Child Care, Inc

Where Learning is Fun!!

KIDazzle Child Care & Learning Center Enrollment Application

Enrollment Package

Sponsor Information:

Sponsor's Name:

Co-Sponsor's Name:

Child's Living Arrangements & Child General Information:

Child's Name:

Emergency Contacts and Authorized Releases

Name:

Address:

Address:

Phone:

Child's Medical Information:

Parent/Guardian Signature:

Parental Agreement Form

Emergency Medical Authorization

Safe Sleep Policy

Infant Feeding Plan

KIDazzle Child Care External Preparations Authorization