if yes, please attach a copy of the court order to keep on file at cmlc

WAIVER OF RESPONSIBILITY

I hereby consent to have my child participate in walks or rides away from the school grounds to nearby points of interest.

I authorize the director to call the emergency ambulance in case of accident or acute illness and to allow for possible emergency medical or surgical care in case i am not immediately available. It is understood that a conscientious effort must be made to notify my spouse or me.

I am aware that the community care licensing agency has the right to interview my child without giving prior consent to anyone.

List of those authorized to remove my child from school:

Creative Montessori Learning Center

APPLICATION OF PRESCHOOL ADMISSION

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SCHOOL POLICY 

The montessori program is appropriate for the vast majority of children. Nonetheless, there are a few children with special needs or problems who do not function well in the montessori environment, for example, the children with excessive needs for attention or who exhibit a great deal of aggressive behavior may not be well served here.

For this reason, we reserve the right to request that you withdraw your child from the school if we feel that your child's presence in the classroom is not in the child's best interest or seriously hampers the effectiveness of the program. This request would not be made without extensive prior consultation between you and our staff and would be a joint decision of our staff and board of directors. Of course, if we find it necessary to make such a request of termination, our staff and board of direc- tors will do whatever possible to help you find the best preschool environment for your child.

I have read the policy statement above and agree to its terms. 

Creative montessori learning center is operated on a non-discriminatory basis, according equal treatment and access to services, without regard to race, color, religion, national origin or ancestry.

6. Please note anything that might be helpful to our staff in working out a successful plan for your

State of california Health and human services agency

california department of social services community care licensing division

to be completed by parent or authorized representative

Father's/guardian's/father's domestic partner's name

Mother's/guardian's/mother's domestic partner's namelast

Additional persons who may be called in an emergency

Physician or dentist to be called in an emergency

Names of persons authorized to take child from the facility (child will not be allowed to leave with any other person without written authorization from parent or authorized representative)

To be completed by facility director/administrator/family child care homes licensee

State of california-health and human services agency

callion na department UI social ser vices

Child's preadmission health history-parent's report

Developmental history (*For infants and preschool-age children only)

Past illnesses - check illnesses that child has had and specify approximate dates of illnesses:

Daily routines (*for infants and preschool-age children only)

Diet pattern: (what does child usually Eat for these meals?)

State of california - health and human services agency        california department of social services                                                                                                                   community care licensing division 

Child care center notification of parent's rights

Parents' rights

As a parent/authorized representative, you have the right to:

1. Enter and inspect the child care center without advance notice whenever children are in care.
2. File a complaint against the licensee with the licensing office and review the licensee's public file kept by the licensing office.
3. Review, at the child care center, reports of licensing visits and substatiated complaints against the licensee made during the last three years.
4. Complain to the licensing office and inspect the child care center without discrimination or retaliation against you or your child.
5. Request in writing that a parent not be allowed to visit your child or take your child from the child care center, provided you have shown a certified copy of a court order.
6. Receive from the licensee the name, address and telephone number of the local licensing office.

   Licensing office name: Community Care Licensing

   Licensing office address: 801 Traeger Avenue, Suite #100, San Bruno, CA 94066

   Licensing office telephone #: 650-266-8843

1. Be informed by the licensee, upon request, of the name and type of association to the child care center for any adult who has been granted a criminal record exemption, and that the name of the person may also be obtained by contacting the local licensing office.
2. Receive, from the licensee, the caregiver background check process form.

Note: california state law provides that the licensee may deny access to the child care center to a parent/authorized representative if the behavior of the parent/authorized representative poses a risk to children in care. For the department of justice "registered sex offender"database, go to www.meganslaw.ca.go

(detach here give upper portion to parents)

A c k n ow I e d g e m e n t  o f  n ot i f i c at i o n  o f   p a r e n t s' rights (parent/authorized representative signature required)

I, the parent/authorized representative of {childsFull3}, have received a copy of the "child care center notification of parents' rights" and the caregiver background check process form from the licensee.

Creative Montessori Learning center

Name of child care center

 

this acknowledgement must be kept in child's file and a copy of the notification given to parent/authorized representative.

for the department of justice "registered sex offender"database go to www.meganslaw.ca.gov

State of california - health and human services agency                    California department of social services                                               

Personal rights

Child care centers

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Personal rights, see section 101223 for waiver conditions applicable to child care centers.

1. Child care centers. Each child receiving services from a child care center shall have rights which include, but are not limited to, the following:
   1. To be accorded dignity in his/her personal relationships with staff and other persons.
   2. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
   3. To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
   4. To be informed, and to have his/her authorized representative, if any, informed by the licensee of the provisions of law regarding complaints including, but not limited to, the address and telephone number of the complaint receiving unit of the licensing agency and of information regarding confidentiality.
   5. To be free to attend religious services or activities of his/her choice and to have visits from the spiritual advisor of his/her choice. Attendance at religious services, either in or outside the facility, shall be on a completely voluntary basis. In child care centers, decisions concerning attendance at religious services or visits from spiritual advisors shall be made by the parent(s), or guardian(s) of the child.
   6. Not to be locked in any room, building, or facility premises by day or night.
   7. Not to be placed in any restraining device, except a supportive restraint approved in advance by the licensing

The representative/parent/guardian has the right to be informed of the appropriate licensing agency to contact regarding complaints, which is:

801 traeger avenue, suite #100

To: parent/guardian/child or authorized representative:

Upon satisfactory and full disclosure of the personal rights as explained, complete the following acknowledgment:

acknowledgment: i/we have been personally advised of, and have received a copy of the personal rights contained in the california code of regulations, title 22, at the time of admission to:

Creative Montessori Learning Center

1421 Bay Rd. E Palo Alto, CA 94303

State of california health and human services agency                                     California department of social services

Important information for parents

Caregiver background check process california department of social services

The california department of social services works to protect the safety of children in child care by licensing child care centers and family child care homes. Our highest priority is to be sure that children are in safe and healthy child care settings. California law requires a background check for any adult who owns, lives in, or works in a licensed child care home or center. Each of these adults must submit fingerprints so that a background check can be done to see if they have any history of crime. If we find that a person has been convicted of a crime other than a minor traffic violation or a marijuana-related offense covered by the marijuana reform legislation codified at health and safety code sections 11361.5 and 11361.7, he/she cannot work or live in the licensed child care home or center unless approved by the department. This approval is called an exemption. 

A person convicted of a crime such as murder, rape, torture, kidnapping, crimes of sexual violence or molestation against children cannot by law be given an exemption that would allow them to own , live in or work in  a licensed child care home or center. If the crime was a felony or a serious misdemeanor, the person must leave the facility while the request is being reviewed. If the crime is less serious, he/she may be allowed to remain in the licensed child care home or center while the exemption request is being reviewed.

How the exemption request is reviewed.

We request information from police department, the FBI, and the courts about the person's record. We consider the type of crime, how many crimes there were, how long ago the crime happened and whether the person has been honest in what they told us.

The person who needs the exemption must provide information about:

• The crime
• What they have done to change their life and obey the law
• Whether they are working, going to school, or receiving training
• Whether they have successfully completed a counseling or rehabilitation program

The person also gives us reference letters from people who aren't related to them who know about their history and their life now.

We look at all these things very carefully in making our decision on exemptions. By law this information cannot be shared with the public.

How to obtain more information

As a parent or authorized representative of a child in licensed child care, you have the right to ask the licensed child care home or center whether anyone working or living there has an exemption. If you request this information, and there is a person with an exemption, the child care home or center must tell you the person's name and how he or she is involved with the home or center and give you the name, address and telephone number of the local licensing office. You may also get the person's name by contacting the local licensing office. You may find the address and phone number on our website. The website address is http://ccld.ca.gov/contact.htm.

Part a - parent's consent (to be completed by parent)

is being studied for readiness to enter

creative montessori learning center (name of child care center/school)

Please provide a report on above-named child using the form below. I hereby authorize release of medical information contained in this report to the above-named child care center.

Part b - physician's report (to be completed by physician)

Immunization history: (fill out or enclose california immunization record, pm-298

(diphtheria, tetanus and [acellular] pertussis or tetanus and diphtheria only)

(required for child care only)

SCREENING OF TB RISK FACTORS (listing on reverse side)

reviewed the above information with the parent/guardian.

Date of physical exam: date this form completed: signature

Risk factors for tb in children:

Have a family member or contacts with a history of confirmed or suspected tb. Are in foreign-born families and from high-prevalence countries (asia, africa, central and south america Live in out-of-home placements. Have, or are suspected to have, hiv infection. Live with an adult with hiv seropositivity. Live with an adult who has been incarcerated in the last five years. Live among, or are frequently exposed to, individuals who are homeless, migrant farm workers, users of street drugs, or residents in nursing homes. Have abnormalities on chest x-ray suggestive of tb.

Consult with your local health department's tb control program on any aspects of tb prevention and treatment.

 

 

Child care center notification of parent's rights

Parent's rights

As a parent/authorized representative, you have the right to:

1. Enter and inspect the child care center without advance notice whenever children are in care.
2. File a complaint against the licensee with the licensing office and review the licensee's public file kept by the licensing office.
3. Review, at the child care center, reports of licensing visits and substantiated complaints against the licensee made during the last three years.
4. Complain to the licensing office and inspect the child care center without discrimination or retaliation against you or your child.
5. Request in writing that a parent not be allowed to visit your child or take your child from the child care center, provided you have shown a certified copy of a courtorder.
6. Receive from the licensee the name, address and telephone number of the local licensing office.

  Licensing office name:  Community care licensing

  Licensing office address: 801 Traeger Avenue, Suite #100, San Bruno, CA 94066