ABC Care 4 Day In Person Model Registration 2020

Parent/Guardian Information
Only parents/guardians listed on this sheet will have access to information about child's care.
Parent/Guardian *

First Name Last Name
Relationship to Child *
Same Address as Child?

Yes
Address *

Street Address

Street Address Line 2

City State

Zip Code
E-mail *
Cell Phone *
Home Phone
Work Phone
Additional Parent/Guardian ABC is authorized to discuss this account with:

First Name Last Name
Relationship to child?
Same Address as Child?

Yes
Address

Street Address

Street Address Line 2

City State

Zip Code
Phone
E-mail
example@example.com
In SmartCare, our attendance and billing program, the first parent/guardian listed is the account holder and considered the primary parent. That parent has access to all areas of SmartCare including, but not limited to, billing, attendance, schedule, etc. The second parent/guardian listed can have access to the attendance portion of the app, can share billing information with the primary parent, and/or can have their own billing account information for cases where parents/guardians are splitting the cost and payments. Please choose the role of the second parent/guardian listed below:

Only needs access to the attendance portion of the app. Does NOT need access to any billing/payment information Will need attendance portion of the app AND access to the same billing/account information as the primary parent Will need attendance portion of the app AND their own separate billing/payment account for their portion of the bill
If parents are having separate billing accounts, please list the percentage of billing to go to primary parent ___ and percentage of billing to go to secondary parent ___
Signature: (hold down left pointer button on mouse to sign) *

Clear
Date Signed *

Month Day Year

Additional Authorized Person(s)
Our SmartCare App provides parents with a QR code to easily and quickly check-in and check-out their children. We are able to give a QR code to additional authorized people that may be dropping off or picking up your children regularly. Please list any additional people here, along with their email and phone number.

*ONLY list people who will be regularly picking up or dropping off. If you need to add more than two names, please contact our main office.

*Parents and Guardians listed on the page prior are already listed as authorized pick up people, you do not have to list them here.
Name

First Name Last Name
Email
example@example.com
Phone
Relationship
Name

First Name Last Name
Email
example@example.com
Phone
Relationship
In EMERGENCIES requiring immediate medical attention, your child will be taken to the NEAREST HOSPITAL EMERGENCY ROOM. Your signature authorizes the responsible person at the center to have your child transported to that hospital. Please sign below. (hold down left pointer button on mouse to sign) *

Clear
Date *

Month Day Year
Date

Please take a moment to review the ABC Care 2020-2021 Parent Manual, Maryland Department of Health & The Maryland State Department of Education COVID-19 Guidelines for Child Care Facilities as well as the Guide to Regulated Child Care brochure.
2020-2021 ABC Care All Day Care Parent Manual
2020-2021 ABC Care Before/After Care Parent Manual
Maryland Department of Health & Maryland State Department of Education COVID-19 Guidelines for Child Care Facilities
Guide to Regulated Child Care
I have read the ABC Care 2020-2021 Parent Manual as well as the Maryland Department of Health & Maryland State Department of Education COVID-19 Guidelines for Child Care Facilities and will abide by the information and policies set forth by ABC Care. I have received and reviewed the brochure "Guide to Regulated Child Care", a guide written by the Child Care Administration. I understand and agree that all disputes go to mediation prior to court.
Signature *

Clear
Date *

Month Day Year
Date

Referral Program

Enrollment Referrals
This school year will be an exciting one at ABC Care. Why not enjoy it with your friends? If you know of a potential new family who has never attended an ABC Care before and after school year program, please submit their contact information using the form below. If the referral joins ABC Care this school year, you will receive a $25 credit towards tuition. Referred family need only to register and attend for 1 month for school year. You must be a current registered family with your account in good standing when the referred family joins. Upon full payment by your referral, the referring family will receive their credit. There will be no cash refund of the referral credit.

**This form will be available on our website (abccareinc.com) for you to use throughout the school year.
Your Information:
Your Full Name:

First Name Last Name
Your Phone Number:

Area Code Phone Number
Child's Name Attending:

First Name Last Name
Which ABC Center does your child attend?
Date

Month Day Year
Date
Name of ABC Care Staff who spoke to me:
Information for family you are referring:
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number

ENROLLMENT/PAYMENT INFORMATION
Please note: Enrollment is not complete until ALL required paperwork as outlined on page 7 of the Parent Manual is turned in to the ABC Care Main Office and you receive an enrollment confirmation email. Waiting lists may apply when enrollment reaches site capacity.

At the time of registration, a $75 per returning family OR $100 new family, non-refundable, registration fee is due. First weeks tuition payment is also due at the time of registration.
Do you receive any supplemental childcare benefits from any government agency? To check and see if you are eligible for benefits, visit www.money4childcare.com. *

Yes No
If Yes, please indicate the name of the agency: (ABC Care does accept a limited number of government- subsidized families in our program. Upon receipt of application and registration fee, notice of confirmation in writing will be issued.)
Is your child receiving intervention services through the school? If yes,please provide copy of IEP/IFSP/504 Plan so the Director is aware of modifications necessary (All information will remain confidential). *

Yes No
ABC Care will operate with a weekly billing contract during the hybrid learning model. Weekly rates are based upon the total number of days the child is registered for weekly. Payments are due on the Friday prior to the week attending.

Families using automatic recurring credit card or bank payments will have funds withdrawn on the Friday prior to the week of care. Families paying by check or money order must have payments delivered to the center or main office by the Friday prior to the week attending

We have three (3) billing options.

Option #1: Weekly recurring ACH withdrawals to be made directly from bank account. The draw will be initiated on the Friday prior to the week of care. There will be no fees for this option.

Option #2: Weekly recurring automatic credit card payments to be made on the Friday prior to the week of care. This option will be assessed a 2.85% processing fee.

(Example: $100 due x 2.85% = $102.85)

Option #3: Non-Automatic Payment. Can be paid via check, money order, or self-process payment through the SmartCare system via ACH or Credit Card and will be due on the Friday prior to the week of care.

PLEASE NOTE: Check, Money order, and ACH withdrawals incur no additional fees. ALL credit card payments are subject to a 2.85% processing fee.
Once registration fees have been paid, please choose which billing option your would prefer. Reminder: ALL PAYMENTS ARE DUE WEEKLY BY FRIDAY PRIOR TO THE WEEK OF CARE. *

Option #1 Automatic ACH Option #2 Automatic credit card Option #3 Non-Automatic Payment
If you choose Option 1 or Option 2 and have a card on file from last year, please verify last four digits of card you wish to use:
By signing this registration agreement on behalf of my child, I acknowledge I am financially responsible for the services indicated on the registration form. This contract will begin October 19th thru the end of the hybrid learning model.
Signature: (hold down left pointer button on mouse to sign) *
Date Signed *

Month Day Year

Please take a moment to read the instructions for filling out the information on the Maryland State Department of Education, Office of Child Care, All About My Child Form.
All About My Child
Child's Name *

First Name Last Name
Child's Nickname:
THINGS MY CHILD DOES WELL:
WHAT MY CHILD LIKES/DISLIKES:
THINGS I AM WORKING ON WITH MY CHILD:
MY CHILD ENJOYS THESE PHYSICAL ACTIVITIES:
MY CHILD HAS DIFFICULTY WITH THESE ACTIVITIES:
MY CHILD WILL NEED THE FOLLOWING EQUIPMENT AND/OR ROUTINES:
THINGS MY CHILD MIGHT NEED HELP WITH:
Signature *

Clear
Date *

Month Day Year
Date

PUBLICITY/PHOTOGRAPHY/VIDEO RECORDING RELEASE
From time to time our program may involve photography, video recording, interviewing by an outside source, and other publicity pictures of the children in our program.

It is required by our licensing agent, Maryland State Department of Education (MSDE), that parents/guardians grant permission for this type of publicity.
My child: *

may be photographed, video recorded or interviewed may NOT be photographed, video recorded or interviewed
Child's Name *

First Name Last Name
Parent's Signature: (hold down left pointer button on mouse to sign) *

Clear
Date *

Month Day Year
Date

TRANSPORTATION AUTHORIZATION
I give ABC Care, Inc. permission to transport my child, listed below, by certified school bus service and/or ABC Care, Inc. van to and from all field trips, and between all ABC Care, before and after care school centers.

In case of emergency such as a natural disaster or national emergency, your signature on this blanket permission slip allows your child/ren to be transported by a Maryland certified bus company or ABC Care, Inc. staffer vehicle to the nearest disaster relief shelter. ABC Care, Inc. will notify parents/guardians of children’s emergency location via telephone call. The emergency telephone number (s) we use to contact parents/guardians are listed on the child’s emergency form.

I understand that all necessary precautions will be taken by ABC Care, Inc. for the safety of my child.
Child's Name *

First Name Last Name
Parent Signature: (hold down left pointer button on mouse to sign) *

Clear
Date *

Month Day Year
Date

BEHAVIORAL MANAGEMENT PLAN

PROCEDURES REGARDING INAPPROPRIATE BEHAVIOR
Minor behavioral problems will be handled by the center’s Site Director through verbal warnings, “cool down time”, Problem Solving Sheets and Incident Reports. Both the Problem Solving Sheets and Incident Reports must be reviewed with the parent and the parent is required to sign the incident report.

Parent Conferences

Three (3) Incident Reports within a two (2) week period constitutes a parent conference to be held within one (1) week of the last Incident Report. These parent conferences will be held between the hours of 7:45am and 4:45pm and will be held either at the child’s ABC Center or at the main office located at 2815 Patapsco Road, Finksburg, MD.

Procedures Regarding Inappropriate Behavior

A child who is involved in any type of behavior that is determined by the Site Director, and Executive Director or Senior Managers of ABC Care, Inc. to be conduct unacceptable for a child attending an ABC Care Before and After School Program, can be suspended or expelled. The Executive Director or Senior Managers have the authority to determine the length of the suspension, which can range from one (1) to five (5) days.
1. ABC Care Inc. reserves the right to employ the following procedures in dealing with instances of inappropriate behavior:The Site Director of the center may confiscate inappropriate and/or objectionable materials and/or objects that may be used for inappropriate behavior.
2. The Site Director of the center, with the Senior Manager’s guidance, reserves the right to determine the degree of punishment (i.e. Incident Reports, suspension, expulsion)
3. The Executive Director or Senior Managers have the right to request full payment for total replacement and/or monetary reimbursement for repairs and/or replacement of broken/destroyed objects resulting from a deliberate or accidental breakage. This includes center equipment, school items, and children/staff personal belongings.
4. Field trips are a privilege. The Site Director of the center reserves the right to withhold a child from attending a field trip.
5. The Site Director of the center reserves the right to request that a child’s parent accompany him/her while attending a field trip.
6. The Executive Director or Senior Managers reserve the right to require counseling and/or psychological testing.
Offenses

The following lists are examples of SOME of the offenses for which a child may receive an Incident Report, suspension, or expulsion, depending on the circumstances and severity surrounding the offense.

Incident Reports
- Leaving the designated area that ABC Care is utilizing at that time.
- Throwing rocks, sticks, etc.
- Failure to refrain from hurting another (pinching, pushing, punching, biting, kicking, etc...)
- Using vulgar language, verbally or in written form
- Showing disrespect to another person (child or staff member)
- Improper use of equipment, materials, or furniture
Suspensions which may result in expulsion
- Failure of parent(s) to attend a parent conference or adhere to its recommendations
- Theft/Robbery
- Use or possession of tobacco or firearms
- Arson/lighting matches
- Assault and battery of a staff member
- Violent behavior which creates a substantial danger to persons or property
- Possession of a real or look-a-like weapon
- Destruction and vandalism of school or personal property
- Fire alarm misuse
- Harassment
- Insubordination (disobeying a directive from a Director or School Age Child Care Teacher)
- Gambling for money
- Lack of required immunizations or health inventories
- Sexual activity or indecent exposure
I have read and understand the behavioral management plan of ABC Care, Inc. and the procedures regarding inappropriate behavior and will agree to their implementation. Parent's Signature: (hold down left pointer button on mouse to sign) *

Clear
Date *

Month Day Year
Date

Should be Empty:

4 Day In Person Model Registration

Child's Information

Parent/Guardian Information

Additional Authorized Person(s)

Referral Program

Your Information:

Information for family you are referring:

ENROLLMENT/PAYMENT INFORMATION

PUBLICITY/PHOTOGRAPHY/VIDEO RECORDING RELEASE

TRANSPORTATION AUTHORIZATION

BEHAVIORAL MANAGEMENT PLAN