Emergency Contact Information-Alternate Pick-Release
Emergency Contact #1
Emergency Contact #2
Your child will not be released to anyone that is not listed above. Please contact us in advance for occasions where an individual not listed will be picking up your child.
Medical Release Information
The purpose of the above listed information is to ensure that medical personnel have details of any medical condition which may intefere with or alter treatment.
I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured.
Terms of Agreement
The Therapeutic Learning Center is not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded unless a child is unable to participate due to an accident or illness per physician orders.
THERAPEUTIC LEARNING CENTER, LLC
Permission Slip, Waiver of Liability, Indemnification, Medical Agreement
and Grant of Rights
I, the parent/legal guardian of this participant, hereby confirm that I am allowing my child to participate in the Therapeutic Learning Center, LLC’s (“TLC”) Preschool Prep Programs (“Program”). I understand that the Program is completely voluntary and that no academic credit will be given for participation. My signature below is an acknowledgment of voluntary consent to allow my child to participate in this Program.
Waiver of Liability
My signature below indicates my understanding of the details of the Program. On behalf of my child, I voluntarily agree to accept any and all risks associated with their participation in the Program. On behalf of my child, I agree to forever indemnify, hold harmless, waive, and release TLC, its respective officers, members, employees, insurers, and representatives (“TLC Group”) thereof, from liability for any claim which I, any other parent or guardian, any sibling, the student, or any other person, firm or corporation may have or claim to have on my behalf or on behalf of my child, known or unknown, directly or indirectly, for any losses, damages, or injuries, including death, arising from, but not limited to, negligence, omissions, or fault, by or on behalf of TLC.
I agree to indemnify and hold harmless TLC Group from and against any and all claims, demands, expenses, losses and liability arising out of personal injuries or death to any person or the damage, loss or destruction of any property which may occur or in any way grow out of any act or omission by my child or any and all costs, expenses and/or attorney fees incurred as a result of any claims, demands, and/or causes of action, through, or under my child which may arise as a result of his or her participation in the Program.
If the participant has any special medical problems, allergies, dietary needs, disability, special prescriptions, etc., please list (and use additional sheets if necessary) I have explained them in the registration form above.
In case of an emergency, all attempts to reach me should be made to the telephone number(s) stated above on the registration form.
If any emergency medical procedures or treatments are required during the Program, I hereby consent to the staff of TLC’s Program, arranging for, or consenting to the procedures or treatment in his, her, or their discretion. The only time a decision will be made in regard to serious illness or accident will be when extenuating circumstances prevent direct contact with parents/guardians regarding the matter. My signature below also indicates that my child is in adequate physical condition to participate in the Program.
GRANT OF RIGHTS
I, Parent/Legal Guardian, grant TLC the right and license to use my child’s liken, photographs and other attributes (collectively, “Approved Attributes”) to promote and advertise TLC’s services in the media including TV, radio, print advertising, point-of-sale materials, promotional materials, grassroots marketing efforts, public relations efforts and the Internet (to include but not be limited to web banners, blogs, and social networking sites).
By signing a copy of this agreement, I hereby acknowledge and agree to the above terms, including the PERMISSION SLIP, WAIVER OF LIABILITY, INDEMNIFICATION, MEDICAL AGREEMENT, and GRANT OF RIGHTS. I have reviewed and read this agreement. The terms and conditions were explained to me in full, and I understand its terms and conditions. I have been given ample opportunity to review this agreement with an attorney of my choosing. My signature below is voluntary. I further certify that I am of full legal capacity to execute this authorization.
The Undersigned expressly agrees that the foregoing Release, Waiver and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Louisiana and that if any portion or portions thereof shall be held invalid, it is agreed that said portion shall be severed from this Agreement and the balance shall notwithstanding, continue in full legal force and effect.
Tuition Payment Policy
Intent Statement Therapeutic Learning Center collects tuition for each child in our care to maintain financial obligations of our staff and on site upkeep. This also enables us to maintain a quality program and grow to provide services to everyone in need.
Tuition As of the effective date, tuition will be due in full on the 5th day of each month. Your child’s tuition will be based on the number of scheduled days they are to attend the program that month, and will vary depending on if you have chosen the 2-day, 3-day, or 5-day option.
Payment Procedure Administration will send a monthly invoice via your chosen method of contact by the 1st of every month. Payment is due in full by the 5th and will serve as tuition for the remainder of the month. This process will be repeated monthly as your child continues enrollment in our program. Please contact administration promptly if you have any concerns or questions regarding your monthly invoice.
Late PaymentIn the event that monthly tuition is not paid in full by the 5th of the month, we reserve the right to charge a $25 late fee. If payment is not received within a week of the due date, we reserve the right to discharge your child from the program.
Late Pick Up Pick up should be prompt and between 2:30 pm and 3:00 pm. In the event of pick up after 3:00 pm, we reserve the right to charge a $25.00 late fee which must be paid within one week of issuing.
Late Arrival In the event of late arrival time, we will not prorate for the time your child missed for their regularly scheduled day.
Graduation Discharge Policy In the event that your child is discharged or graduates from the program in the middle of the month, you will receive a refund for the remainder of days in which your child was scheduled for. Official discharge/graduation will be determined during a parent meeting with staff in which all agree that your child has met all established goals and is no longer appropriate for a transitional program. We will not graduate a child unexpectedly without alerting parents in advance and ensuring that a transition plan is in place to get your child into a typical school environment of your choosing.
Unexpected Discharge/Discontinuation Refunds will not be issued for unexpected discharge or discontinuation of the program for any of the following reasons.
Child behavior is beyond our ability to control, which is harmful to others or themselves. No tuition or fees will be reimbursed. If it is determined that your child is not appropriate for our program and is discharged due to this reason, any funds paid for the remainder of the month will be refunded.Parental decision to pull from program without warning (see below)Noncompliance with payment or other site policies and procedures
Shadow PolicyIf your child requires a one on one shadow to participate in the program, please communicate with our administration prior to attending. (TLC is unable to provide a shadow; however, we will accommodate if provided by family.)
Program Withdrawal In the event that you wish to withdraw your child from the program at any time, we request a two week written notice to be provided to administration. Reimbursement will be issued if provided an official notice prior to two weeks of withdrawal. If two weeks are not allotted, withdrawal will be deemed unexpected and reimbursement will not be issued.
Unexpected AbsencesRefunds or prorating will not be issued for unexpected absences, early pick up, or late arrival. This is including but not limited to sick days, vacation days, or leaving early/arriving late due to personal commitments or prior appointments.
Weather Closures Refunds will not be issued in the event of unexpected TLC office closure due to inclement weather.
Expected Absences /Vacation in the event of a planned absence from the program, we will only issue a refund for scheduled days in the event that we are notified 2 weeks prior to your child missing. Administration should be notified via phone call or email.
Holiday ClosuresTLC will not charge tuition for holiday closures, and this will be reflected on your monthly invoice prior to the 5th of the month due date. If the center is open, and you wish to keep your child home around a holiday time, please refer to the above unexpected absences and vacation policy. We request a two week notice for any absence for the program in order for you to be eligible for a refund.
READ BEFORE SIGNING
Check the day and time you wish to enroll your child. Please contact the office to provide a payment method or use the payment options below.