Michelle International Learning House Registration Form

1800 Cathedral Drive, Margate, FL 33063

Tel: 954-972-0437 Fax: 954-972-4889

Michelleslearninghouse@gmail.com

www.Michelleslearninghouse.com Register online for $5.00 off!

Federal ID #462296210

Participants Name *

First Name Last Name

Emergency Code *

Gender *

Date of Birth (DOB) *

Date

Child Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Insurance Company *

Policy # *

Allergies *

Parent #1 Name *

First Name Last Name

Parent 1 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Parent 1 Home Phone # *

Area Code Phone Number

Parent 1 Cell Phone # *

Area Code Phone Number

Parent 1 Employer *

Parent 1 Work Phone # *

Area Code Phone Number

Parent 1 Email *

example@example.com

Parent #2 Name (if no 2nd parent, write NA throughout) *

First Name Last Name

Parent 2 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Parent 2 Home Phone # *

Area Code Phone Number

Parent 2 Cell Phone # *

Area Code Phone Number

Parent 2 Employer *

Parent 2 Work Phone # *

Area Code Phone Number

Does your child have an IEP? *

Yes No

If yes, would you be willing to share the IEP with us? *

Yes No

Parent 2 Email *

example@example.com

Parent 1 may pick-up or be notified in case of illness, accident, or emergency? *

Yes No

Parent 2 may pick-up or be notified in case of illness, accident, or emergency? *

Yes No

Additional Emergency Pick-Up/Notification #1 Name *

First Name Last Name

Additional Emergency Pick-Up/Notification #1 Relationship *

Additional Emergency Pick-Up/Notification #1 Phone # *

Area Code Phone Number

Additional Emergency Pick-Up/Notification #1 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Additional Emergency Pick-Up/Notification #2 Name *

First Name Last Name

Additional Emergency Pick-Up/Notification #2 Phone # *

Area Code Phone Number

Additional Emergency Pick-Up/Notification #2 Relationship *

Additional Emergency Pick-Up/Notification #2 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Physician Name *

First Name Last Name

Physician's # *

In the event I cannot be reached in an emergency, I give consent to Michelle's International Learning House to select a physician, and for said physician to hospitalize, secure proper treatment for, and to order, inject and/or anesthesia and/or surgery for my child, as named above. I understand that Michellle's International Learning House has secondary insurance coverage and that the personal insurance bears primary responsibility in case of accident. The undersigned expressly recognizes that there are risks in children's play and I hereby grant permission for my child to use all of the playground equipment and to participate in all activities of the school.

Parent/Guardian Signature *

Clear

Date: *

Date

Photography Consent Form:

Dear Parent/Guardian,

As the parent of a child(ren) at Michelle's International Learning House, I agree to the following:

I understand that my child(ren) whose name(s) are listed below may be photographed at International Learning House during normal childcare hours, field trips, or activities. I understand that these photographs may be used in promoting child care services, either in print or on the internet.

Parent/Guardian Name *

First Name Last Name

Relationship to child *

Child 1 Name *

Child 2 Name

Child 3 Name

Child(ren) Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

I give permission for my child(ren) to be photographed, or their images recorded for print or electronic use in promoting our child care services. I understand that it is my responsibility to update this form in the event that I no longer wish to authorize the above uses. I agree that this form will remain in effect during the term of my child's enrollment. I understand that there will be no payment for me for my child's participation

Parent/Guardian Signature *

Clear

Parent/Guardian Print Name *

Date *

Date

Dear Parent: In accordance with Broward County Child Care Ordinance, parents and the child care facility are urged to work cooperatively to assure that children are provided with nutritious snacks and meals where lunches are not provided by the facility. Please read the following carefully, sign, and return as soon as possible. The facility agrees to provide a nutritious: The parent agrees to provide a nutritious:

mid-morning snack
lunch
mid-afternoon snack.

I have read the preceding and agree to meet the child's nutritional needs as defined above.

Date *

Date

Parent's Signature *

Clear

Date *

Date

Parent/Guardian Release of Information

Michelle's International Learning House is held accountable by county, state and our accreditation agency. These entities do periodic inspections and may randomly choose children's files for compliance checks. In addition, in case of an emergency, Michelle's House staff may need to access your child's file in order to reach you. Please sign below granting permission to share your child's information with these parties under these, or other necessary circumstances.

Name *

First Name Last Name

Parent/Guardian's Name *

First Name Last Name

Signature *

Clear

Date *

Date

Authorization for Emergency Treatment

To Whom it May Concern:

I hereby give my consent to the hospital below to administer neccessary treatment to my child (named below) in the event of an emergency at which time I cannot be reached. I give consent to transport by ambulance if the situation warrants it

Child's Name *

Today's Date *

Date

My insurance provider is *

Policy Number *

Insurance Expiration Date *

Date

Preferred Hospital *

Name of Physician *

Physician Phone Number *

Area Code Phone Number

Date of Last DPT or Tetanus *

Date

My child has the following allergies: *

Guardian Name *

Signature of Parent/Guardian 1 *

Clear

Date (Parent/Guardian 1) *

Date

Signature of Parent/Guardian 2 *

Clear

Date (Parent/Guardian 2) *

Date

Michelle's International Learning House Corona Virus Pandemic Strategic Plan

Current Recommendations: Childcare centers are being encouraged to remain open to serve those who do not have the ability to work from home.

Phase I - phase I is if the outbreak is in nearby communities but not in our own

Follow CDC and health department recommendations.
Update families on our current status regularly and post any signs provided by the health department
During this phase, if someone NOT interacting with the learning center tests positive, we will evaluate risk to our school.
If deemed necessary, we will close for up to 48 hours so that deep cleaning protocols can be enacted.
If someone within our school tests positive, or has exposure to someone who has tested positive, we will close for 48 hours or longer, depending on CDC recommendations and have heathy staff come in to fully clean based on cleaning procedures recommended by the CDC/health department.
Cleaning and handwashing procedures will be as follows:
- Families will be reminded at pick up and drop to wash their own child's hands for a minimum of 20 seconds.
- During phase 1, we will add additional cleaning for high touch areas at 10am and 4pm. Teachers will be retrained on proper handwashing techniques and ways to help children thoroughly wash their hands.
- Any toys that might be mouthed will be collected and washed immediately and at least daily. All toys will be cleaned and thoroughly sprayed with bleach at the end of each day. All counters, shelves, surfaces will be wiped down with our bleach solution at the end of each day.
- We are increasing the level of our exclusion practice with children and staff. We are asking families to keep children home that show any signs of illness, temperatures of 100 or above will require exclusion until fever free for 24 hours without medication and will require a doctor's note.
- If we are low on staff, we will operate at licensing ratios and if necessary, only accept children up to staff limitations imposed by said ratios, on a first come, first serve basis. Children may be combined with other classrooms to allow the maximum number of families to receive care daily.

Phase II (outbreak is within our community, government is enacting social distancing rues and beginning to shut down high risk areas such as schools, events, etc)

Continue protocols of Phase I unless following extended protocols below
Remain open until mandated to close, as long as no positive results are among staff and families. If a positive result presents itself, we will go to Phase III
Update families with the latest information we receive
Bedding will be sent home daily for laundering rather than weekly.
Increase illness exclusion restrictions. Temperatures of 99.5 or higher will be excluded as will other symptoms such as cough or severe fatigue. Children and staff with these symptoms will be excluded for 72 hours. If symptom free after 72 hours WITHOUT the aid of medication child/staff may return with doctor clearance. If symptoms persist exclusion will be required until a negative corona virus test result is determined.
Staff and families will be updated as quickly as possible.
Enhanced cleaning procedures will include hourly wipe downs of high touch areas, fully disinfecting shelves and toys at closing, remove any high risk/hard to clean toys. Infant and toddler teachers will place toys played with, even if not mouthed in buckets to be washed and disinfected daily, as well as, as needed.
Preschool children will assist in washing toys. Toys and materials will be removed if coughed or sneezed on and at the end of each day, or after high touch use.
All sensory activities involving shared materials will be suspended.
Families are responsible for making sure their contacts are up to date. If a child becomes symptomatic and we cannot reach family or alternative contacts given, authorities will be called.
Staff choosing not to come in will not be paid.
Children will not be permitted to bring items, such as toys, from home.
School age children enrolled in our after- school program and now attending full day, will be charged the full fee.
Social distancing among young children is almost impossible. Children cannot understand this concept. What's more, during these tense uncertain times children need comfort more than ever. We will be encouraging small group play and extended outdoor time.
Require high risk staff to stay home.
All staff will practice social distancing outside of the classroom and best that they can within the classroom.
Staff will wash their hands and the hands of the children together every time to make sure it is done properly.

Phase III (This phase will be enacted if we have a positive test among staff or families. Since we have siblings, we will close the entire school or we will enter this phase if mandated to close)

Day 1 of closure no child care will be provided so that our school can be prepared for possible extended closure.
Resources and information will be shared with families
In the event that we are mandated quarantined as a community, front line responders and health care workers who do not have back up care will be our first priority in aiding them to find back up care for their children.
During mandatory quarantine, we will update families and staff daily through our Remind app and Facebook, and suggest activities for children. We will implement a daily story time video, if possible, as well.

Phase IV (phase IV will have two parts: Part A if a partial quarantine is lifted, but centers are not reopened. Part B is if full quarantine is lifted and we are able to open, but there is still a potential for new cases.)

Part A

As soon as we are able to and partial quarantine is lifted, we will return to Phase III. Health care workers and first responders will again be given priority, and then other families that have been tested and have negative results.
Prepare center to reopen
Reach out to families to determine status
Reach out to staff to determine status
Follow steps in Phase III

Part B

When quarantine is lifted and we are allowed to reopen, we will notify parents of reopening date. Staff will be scheduled to come in to prepare for opening.
Families will be asked to stagger arrival on the first day, so that we may help each child to readjust individually. During extended breaks in care, some children can return easily while others need much comforting. We want to make sure their return is as smooth as possible. We will return to Phase II on the first week of care and Phase I when we feel comfortable, with the goal being week two.
Once the crisis is completely resolved, we will review all of our cleaning and health policies to make sure we are continuing pertinent but common sense practices.

Holiday Observances 2020-2021

School is closed on the holidays listed below. If the holiday falls on a Saturday, the holiday is observed on the Friday preceding the holiday. If the holiday falls on a Sunday, the holiday is observed on the Monday following the holiday.

New Year's Eve - 12/31/20

New Year's Day 1/1/21

President's Day - 2/17/20

Good Friday 4/10/20; 4/2/21
Memorial Day 5/25/20; 5/31/21
Teacher Planning Day 6/5/20; 6/11/21
Independence Day 7/3/20
Teacher Planning Day 8/17/20 & 8/18/20
Labor Day 9/7/20
Thanksgiving Day and day after 11/26/20 & 11/27/20
Christmas Eve Day 12/24/20
Christmas Day 12/25/20

Physical Activity

I grant permission for my child to participate in physical activitiy at Michelle's International Learning House. I am aware that my child will participate in at least forty (40) minutes of physical activity for every three hours in child care. I confirm that my child has no limitations that would prevent him/her from participating. In the event that weather does not allow for outdoor play, my child's teacher will utilize the inclement weather activities to ensure that the children participate in physical activity indoors.

Proper attire must be worn by children at all times. Rubber -soled, closed shoes must be worn. Clothing should not have long drawstrings or other tripping hazards, including overly long pants or skirts. Clothing should be comfortable and weather appropriate.

Children are scheduled for playground time both in the morning and the afternoon.

Child's Name *

Parent's Name *

Parent's Signature *

Clear

Date: *

Date

We are excited to offer the safety, convenience and ease of Tuition Express—a payment processing system that allows secure, on-time tuition and fee payments to be made from either your bank account or credit card.

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FORBANK ACCOUNT and CREDIT CARD

I (we) hereby authorize Michelle's International Learning House the below-referenced credit card account (Section A) OR, initiate debit entries to my (our) checking or savings account, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. Credit union members: please contact your credit union to verify account and routing numbers for automatic payments. Check with the center for accepted credit card types.

School Name

Cardholder Name

Phone #

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Account Number

Expiration Date

Date

Cardholder Signature

Clear

Signature Date

Date

Your Name

Phone Number

Area Code Phone Number

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Bank or Credit Union Name

Bank or Credit Union Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Routing Transit Number

Account Number

Account Type

Checking Savings

Authorized Signature

Clear

Date Signed

Date

Tuition Express

COMPLETE ONE SECTION ONLY

Section 2

SWIM Central Water Safety Education Questionnare

State Brochures

Distracted Adult Brochure

Please review the Broward Safe Sleep Brochure