Compass Child Care Enrollment

763-381-1616 Con,passCoonRa pids.con,
Compass Location*
Enrollment Agreement

All fields must be completed per State Requirements.
Child's Full Name:*
First and Last Name
Child's Full Name Cover page
Child's Full Name Emergency 1
Child's Full Name Emergency 2
Nickname:
Nickname Emergency 1
Nickname Emergency 2
Date of Birth:

MonthDayYear
Or Due Date
Date of Birth Cover Page

MonthDayYear
Date
Date of Birth:

MonthDayYear
Date
Date of Birth:

MonthDayYear
Date
Gender:
Gender EC 1
Gender EC 2
Address

Child's Address

Street Address Line 2

City, State ZipState / Province

Postal / Zip Code
Program Class:
Schedule

MTWThF
Hours
Approximate drop-off and pick-up times
Siblings Names & Ages:
Parent/Guardian Information

Parent 1
Parent 1 Name:*
Parent 1 Workplace:
Parent 1 Work Phone:
Parent 1 Cell Phone:
Parent 1 Email:*
example@example.com
Parent 1 Address:
Parent 1 City, State, Zip
Parent 1 EC1
Parent 1 EC2
Parent/Guardian Information

Parent 2
Parent 2 Name:
Parent 2 Workplace:
Parent 2 Work Phone:
Parent 2 Cell Phone:
Parent 2 Email:
example@example.com
Parent 2 Address:
Parent 2 City, State, Zip:
Parent 2 EC1
Parent 2 EC2
Parent 1 Work Phone EC1
Parent 1 Work Phone EC2
Parent 2 Work Phone EC1
Parent 1 Cell EC1
Parent 1 Cell EC2
Parent 2 Cell EC1
Preferred way of contact: which parent should be contacted first in an emergency?

Contact Parent 1 FirstContact Parent 2 First
Details of how best to contact Parent 1?
Text, call after 2pm, leave message, email, etc.
Details of how best to contact Parent 2?
Text, call, leave message, email, etc.
Parent 1 Email EC1
Parent 1 Email EC2
Parent 2 Email EC1
Parent 2 Email EC2
Emergency Contact Information:
For the protection of your child, please list below the names and phone number of those persons you authorize to pick up your child from Compass. Emergency contacts must be friends or other family members who do not live with you and are familiar with your child. Compass will only release your child to adults you designate as authorized. It is our policy to ask all unfamiliar adults for photo identification. Please notify the Teacher and Director if someone other than the primary or secondary parent/guardian will be picking up your child on a given day. If they are not listed and/or they do not have identification your child will not be released. You may adjust this list at any time.
Emergency Contact 1

Emergency contacts must be friends or other family members who do not live with you and are familiar with your child.
Emergency Contact 1 (cannot be either parent):
Emergency Contact 1
Emergency Name 1 EC1
Emergency Name 1 EC2
Phone:
Relationship to Child:
Relationship to Child 1 EC1
Relationship to Child 2 EC1
Emergency Phone 1 EC1
Emergency Contact 2 Phone EC1
Emergency Contact 2 Relationship EC2
Parent 2 Cell EC2
Parent 2 Work Phone EC2
Emergency Phone 1 EC2
Emergency Phone 2 EC2
Emergency Relationship 1 EC2
Address:
Emergency Contact 2
Emergency Contact 2 (cannot be either parent):
Emergency Contact 2
Emergency Contact 2 EC1
Emergency Contact 2 EC2
Phone:
Relationship to Child:
Address:
Emergency Contacts Authorized to Pick Up?

Yes, Contact 1Yes, Contact 2
Authorized Pick Up Person 1

Fill in if different than Emergency Contacts.
Full Name:
Authorized to Pick Up 1
Phone
Relationship to Child:
Street Address
City, State, Zip
Confirm authorization to pick-up:

Yes, authorized to pick up
Authorized Pick Up Person 2

Fill in if different than Emergency Contacts.
Full Name:
Authorized to Pick Up 2
Phone
Relationship to Child
Street Address
City, State, Zip
Confirm authorization to pick-up:

Yes, authorized to pick up
In the event that a parent or emergency contact cannot be reached during a minor emergency, Compass will contact 911 and follow the instructions given by emergency personnel. Compass will continue to attempt to contact parents & emergency contacts, until they are reached. In the case of a major emergency 911 will be contacted immediately by 1 staff while a additional staff contacts the parents. By signing below you are stating that you agree to this policy.
Printed Name:
Parent/Guardian
Signature:

Clear
Date:

MonthDayYear
Date
Printed Name:
Parent/Guardian 2
Signature

Clear
Date:

MonthDayYear
Date
Medical Information
Primary Care Doctor:*
Clinic:
Clinic Address:*
Include City, State, Zip
Insurance Company:
Phone:*
Policy Number:
Group Number:
Known Allergies:
Requires additional forms to be filled out prior to enrollment.
Medical Needs:
Requires additional forms to be filled out prior to enrollment.
I understand I need to include the following with my enrollment agreement:

Health Care SummaryImmunization Records
Please include current Immunization Records
Dentist Information

If your child does not have a regular dentist yet, just list any dentist we have permission to call in an emergency. This is a State Requirement.
Dentist*
Clinic/Dentist's Office Name*
Dentist Address:*
Include City, State, Zip
Dental Insurance:
Dentist's Phone:
Policy Number:
Health Information
Does your child have ongoing medical issues:
Ongoing Medications:
HIDE Is your child taking medications (describe):
Any additional medical things we should be aware of:
Child’s Physical Description
Height:
Weight:
Distinguishing Marks:
Hair Color:
Eye Color:
Both

Right HandedLeft HandedBothUnknown
General Information
List Child's Group Care Experience:
Emotional Information
Describe your child's normal temperament:
List any behavioral issues your child may have:
List anything that your child might fear (puppets, vacuum cleaner, etc.):
List anything else we should know that will help your child have an easy transition into our care:
Language(s) spoken at home:
Describe your child's favorite types of toys & activities:
Tips for comforting your child:
Cultures the family considers most important to their identity:
Daily Schedule
What are your child’s sleeping habits?
Let them cry, rock to sleep, etc.
Does your child use a pacifier?

NoYes
How often does your child use a pacifier:

AnytimeNaptime Only
What are your child's eating habits?
Additional dietary needs or prescribed diets:
Anything we should know about their current schedule:
Is your child toilet trained? Check all that apply:*

NoYesTotally TrainedOccasional AccidentsJust Starting
How does your child communicate with you throughout the day?
Additional Information that will Help in the Care of your Child:
Other Information:

My child has an IEP (furnish a copy of this plan to the director before the first day)My child has an allergy (all allergies must be documented with special forms and trainings; this must be completed before your child can attend)
Parent Policies & Tuition Agreement
Tuition: Tuition is due the Thursday before the week the services are provided. Late fee of $25 will be assessed on Friday at noon. If there are 2 weeks with no payment, enrollment will be terminated. Tuition owed will still be due and will be pursued. Tuition is due even if days are missed or in- case of holidays or other school closings. Part time schedules are set, and based on availability, Sibling discount is 10% off the oldest child. There are no discounts for Drop-in care. Rates are subject to change and reevaluated each January.
Initial
Additional Fees: Application fee is $150/child with a $300 cap. This fee is Non-Refundable. Field Trips are additional and optional. The cost varies. If your child does not go on the field trip they will join a class that is not attending the field trip and may not be within his/her age group (a preschooler may spend the day in the toddler room).
Initial
Vacation Policy: We offer vacation benefits to all families who have been enrolled for at least 6 months. Account must be in good standing at time of vacation. You will be granted 1 week. The Director must be notified of vacation 2 weeks prior. For this week your child is not at the center, you will not be required to pay tuition. All other times your child is absent (due to illness, holiday, weather, or emergencies) your full tuition will be due. These vacation days may not be broken up; they must be used in a full Monday-Friday increment.
School closings: We are closed: New Year’s Day, President’s Day, Good Friday, Memorial Day, 4th of July, Friday before Labor Day and Labor Day, Thanksgiving, Friday after Thanksgiving, Christmas Eve and Christmas Day. If the holiday falls on a Saturday, the center will be closed on Friday. If the holiday falls on a Sunday, the center will be closed on Monday.
Weather: We will follow the local school district for snow related school closings. We reserve the right to close for any safety concerns, including, but not limited to loss of power or extreme weather.
Staff Recruitment: We know our staff is great! That is why we have invested so much time and finances in interviewing, screening, training, and development. Any family that recruits a member of our staff to work for them as private childcare will be assessed a $2,000 fee. Outside-of-work-hours babysitting is acceptable and negotiated directly between staff and parents.
Notice: If you wish to remove your child from our program, a written 2-week notice is required. If you choose to remove your child before 2 weeks have passed you will still be required to pay tuition for those 2 weeks.
If you arrive after hours, you will be required to pay the staff directly$1/minute you are late. If child arrives after 10am inform director for staffing and meal purposes.
Parent/Teacher Conferences: We offer parent/teacher conferences 2 times a year. Parents will receive an assessment of skills for their child at this time.
Transportation: If you have registered your child for a field trip you are also authorizing Compass to transport your child to and from said field trip. I understand that all licensing guidelines will be followed.
Diaper Cream: You are authorizing staff to use any diaper cream that is provided by you (parent) as needed.
Sunscreen: You are authorizing staff to use any sunscreen that is provided by you (parent) as needed.
You are authorizing staff to use and apply sunscreen:

Brought in by parentProvided by Compass
Wet Wipes: You are authorizing staff to use any wet wipes provided by you (parent) as needed.
You are authorizing staff to use wet wipes:

Brought in by parentProvided by Compass
Walking Field Trips/Walks: You are authorizing Compass to take your child on walks. All walks will be supervised (above) licensing guidelines and will be for educational purposes.
Photos: You are authorizing Compass to take pictures of your child during classroom activities and field trips. This will be used in-house to document the fun for parents. This includes annual class photos.
Marketing: Some of the photos we take, we will use on social media and marketing. You have the right to refuse the use of your child’s photos.
Marketing photos:

Yes, I am okay with you using photos of my child’s face.Yes, onlineYes, in printNo, I prefer you do not use photos of their face.
Nurse: We have a monthly visit from a public health nurse. This nurse has complete access to child files.
Parent Policies Handbook: You are acknowledging that you received the Parent Policies Handbook and you have read them and are agreeing to the policies outlined in the handbook.
Review Parent Policies Handbook
MN State DHS Licensing Guidelines: We are bound to the guidelines laid out by the DHS. If you would like to see these guidelines there is a copy in the office for your review.
Parent Name 1
Signature

Clear
Date

MonthDayYear
Date
Parent Name 2
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Enrollment Agreement

Parent/Guardian Information

Parent/Guardian Information

Emergency Contact Information:

Emergency Contact 1

Emergency Contact 2

Authorized Pick Up Person 1

Authorized Pick Up Person 2

Medical Information

Dentist Information

Health Information

Child’s Physical Description

General Information

Emotional Information

Daily Schedule

Parent Policies & Tuition Agreement