Little Lambs Daycare Registration Paperwork

Little Learning Academy Registration

PLEASE NOTE: Kidtopia's Daycare Program is available to children ages 6 weeks to 5 years on a first come basis. Once all seats have been filled, a waiting list will be started. There is a $150 registration and supply fee per school year per student. Supply fee and the first week payment is due upon enrollment to reserve placement of your child in the program. A two week written notice is required to withdraw from the program. All payments are non transferable and nonrefundable. Drop off begins at 7 am and pick up by 5:30 pm.
Child's Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Age *
Are you enrolling for full time or part time?*
If part time, please select which days you prefer. (Please know certain days may not be available.)

2 days per week (Tuesday/Thursday)3 days per week (Monday/Wednesday/Friday)
Please select a classroom (aged based selection):*
Gender*

MaleFemale
Does the child have any allergies, chronic illness, or medical conditions?*

YesNo
If yes, please explain:
Has your child attended daycare or preschool before?*
Is your child potty trained?*
Are there any special medical, physical, or emotional needs that the staff needs to be aware of?*
What are you child's favorite activities?*
What do you hope will be included in your child's curriculum?*
Start Date*

MonthDayYear
Date
Parent/Guardian Information
Parent/Guardian #1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number*
E-mail*
example@example.com
Parent/Guardian #2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Number*
E-mail*
example@example.com
I understand that all essentials such as diapers, pull ups, wipes, extra clothes, and any other items my child may need must be brought each day in a bag or carrier labeled with their name.*

Agree
I understand that Kidtopia's Little Learning Academy Daycare program is an active program with physically challenging activities available for student participation.*

Agree
I understand that facility play, climbing walls, indoor and outdoor play equipment, inflatable obstacles, and all activities entail certain risks. Those risk can include increased heart rate, blood pressure, strained or sprained muscles, fractured bones, partial or complete paralysis, heart attacks, psychological injury, death, or possibility of any other serious injury. I elect to allow my child to participate in any and all activities in spite of these risks.*

Agree
I knowingly and voluntarily assume all risks involved in my child's participation and do hereby release Kidtopia, and its members, trustees, officers, employees, independent contractors, and agents from any and all liability, damages, costs, and expenses arising out of or relating to bodily or psychological injury, loss of life or personal property that may occur as a result of participating in this program, regardless of cause.*

Agree
I understand that my child may be photographed and photos may be used in media publications that would represent Kidtopia and its program in a positive manner.*

Agree
I understand that registration and first week payment is due to ensure child's enrollment and is non-refundable.*

Agree
I understand that the weekly tuition/care fee must be pre-paid the Monday prior to care or a $5 late fee will be applied to the account each day payment is not received.*

Agree
I agree to give a two week written notice if I would like to withdraw my child from the program. The remaining balance must be paid in full at the time of notice.*

Agree
I understand that the Kidtopia's Little Learning Academy Daycare program is based on the Madison County School System schedule. If the school system is closed or has decided to delay start times, dismiss early, or cancel school due to severe weather, Kidtopia's Daycare program would then follow that schedule.*

Agree
I understand that bad language and behavior that is disruptive, disrespectful, and/or aggressive will not be tolerated and further agree that dismissal of my child is at the discretion of the Program Director.*

Agree
I give Kidtopia and any employees permission to administer first aid in the event of injury or illness.*

Agree
Kidtopia has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported*

Agree
I have read, understand, and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation in the program.*
Type First and Last name above to consent
Sign Enrollment Agreement*

Clear
Date Signed*

MonthDayYear
Date

My Products

Little Learning Academy Registration Fee

$150.00 Quantity

Total

$0.00

Credit Card

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