Infant Program Registration 2022 FINAL

Head ~ Heart ~ Hands Preschool

400 W. Aspen Ave. Flagstaff, AZ 86001

Web address: www.headhearthandspreschool.org

Email: admin@headhearthandspreschool.org

Owners Email: hhhpfinance2019@gmail.com

Child's Name

Due Date

Date

Birth Date

Date

Age

Mother's (Guardian's) name

Email

example@example.com

(secondary/ work)

Father's (Guardian's) name

Email

example@example.com

Phone Numbers: (cell/home)

(secondary/work)

Attendance Schedule - Check program

($260/ week) Monthly:

Full Time ($980)

Full Time

Part-time is not offered for infants.

Infant Room Deposit-$260 deposit at time of registration which will be placed on hold until

your 3-month anniversary at which time you may choose what week to use your credit. If you disenroll within 90 days, you forfeit your full deposit.

**TUITION WILL BE DUE REGARDLESS OF ATTENDANCE**

First Day of Enrollment

Signature

Date

NEW ENROLLMENT CHECKLIST

Please initial beside each item after completing and signing the appropriate forms. Registration Form Best of Care Form

Registration Form

Best of Care Form

Parent/ Guardian Agreement

Infant Room Specific Guidelines

Safe Sleep Policy

Feeding Instructions

Emergency, Information, and Immunization Record

Parent/ Guardian Agreement Infant Room Specific Guidelines Safe Sleep Policy Feeding Instructions Emergency, Information, and Immunization Record

Please initial beside each item after providing copies:

State issued Photo ID (mother and father or legal guardians)

Immunization Record

State issued Photo ID (mother and father or legal guardians) Immunization Record

Custody Papers (if applicable) What to bring when your infants when they attend (please label all items with first and last name): Bottles with lids (breast milk must be labeled with date pumped and sealed in approved bag) Prepared food for the day Diapers/Wipes Changes of Clothes (stored in clear plastic bag) Parent/Guardian Agreement:

Custody Papers (if applicable)

Bottles with lids (breast milk must be labeled with date pumped and sealed in approved bag)

Date

Prepared food for the day

Diapers/Wipes

Changes of Clothes (stored in clear plastic bag)

My signature below indicates that I have read, understand and agree to the following:

All services require a pre payment and I understand my child may not attend if a pre payment has not been made Wednesday of the attending week. My child may not attend until payment has been paid or arranged and I may risk losing my spot in the program. In order for my child to attend, I must maintain positive balance.

All services require a pre-payment and I understand my child may not attend if a pre-payment has not been made by Wednesday of the attending week. My child may not attend until payment has been paid or arranged and I may risk losing my spot in the program. In order for my child to attend, I must maintain positive balance.

If you do not make your weekly payment by Monday by 5:00pm, you will be charged an additional $50.00 and your child will not be able to attend until balance is caught up. This will be strictly enforced.

I must physically walk my children into the building and sign them in with a full legal signature. All times must be legible. I must also physically walk into the building to sign them out. I must also clock my child in/out on the computer.

In the event a check is returned for non payment, I will be charged a $50 fee and may no longer be allowed to pay check.

In the event a check is returned for non-payment, I will be charged a $50 fee and may no longer be allowed to pay by check.

If discipline becomes an issue with my child, he or she will receive re direction. This will be followed, if necessary, with a quiet time. If discipline continues to be a problem, suspension or expulsion, or behavior plan may be utilized at the Teacher and Director's discretion. At no time will corporal punishment be used as a form of discipline.

My child must be picked up by 5:30pm, unless prior arrangements have been made. I agree to pay a late fee of $1.00 per minute after 6:00pm. I understand that if I am more than 30 minutes late and no one listed on emergency card can be reached, law enforcement officials will be called to pick up my child.

I understand that anyone picking up my child, including myself, may be required to show ID to Staff upon request. I will have immediate access to my child while they are in school, once identified.

Head Heart~Hands Preschool will NOT be liable for medical or other related expenses due to accident or injury to my child.

I must inform Staff of any telephone, address, or other changes to information provided on the Emergency Card.

I understand that Head~Heart~Hands Preschool is based on weekly rate. A non-refundable fee of $100 will be due at time of registration and every year thereafter, due Feb 1st.

Regarding field trips, I understand that I must have my child signed into class by the time listed on the Field Trip Permission Slip. I also understand that I may not pick-up my child from any field trip.

I understand there is a Christian Emphasis to Head~Heart~Hands Preschool.

I understand that Head~Heart~Hands Preschool is a full inclusion preschool program that is offered to children of all abilities, including but not limited to children with special needs (Autism, Cerebral Palsy, Cognitive Disability, Behavioral issues, speech and language difficulties, blindness, deafness, etc

Child's Name (Please Print)

DATE

Date

Parent/Guardian Signature

DATE

Date

Welcome to the Beautiful Butterflies Room at Head ~ Heart ~ Hands Preschool.

Infant Room Specific Guidelines: Please initial each item.

Blankets and toys are not allowed in cribs, please leave them at home. Sleep sacks and thin swaddle blankets are welcome.

Initial

Items you need to provide: diapers, wipes, personal products (powder, creams, lotion, sunscreen, etc with medical consent forms, all formula and food, and extra clothes in a gallon Ziploc bag. The teachers will notify you when you are low or out of items. Initial

Initial

All medication must be brought to the office. A medical consent form must be on file and only trained staff will give medication to the child. We will not dispense medication if form is not on file. Initial

Initial

Your child will be sent home if they have a fever of 100.1, has diarrhea, vomiting, possible pinkeye, or an undiagnosed rash. Please keep your child home until they are symptom free without the use of medication for 24 hours. Exceptions are made if you provide a doctor's note that your child is not contagious. Initial

Initial

Children are not allowed to be propped up in their crib with a pillow unless you provide a doctor's note. Initial

Initial

6. If your child changes their eating or sleeping schedule, please change it on their Infant Feeding Instruction sheet.

Initial

Parents are responsible for bringing all food and it must meet Federal Nutrition Requirements. Please let the teachers know if you have any questions. Initial

Initial

Children are moved to the one-year old program once they are walking and have turned 12 months. The oldest a child can remain in the infant room is 18 months, we can only have 5 one year old in our Loving Lambs Class. You will be expected to pay the tuition in the room your child is enrolled in.

Initial

All personal items (pacifiers, bottles, clothes, etc MUST be labeled with FIRST and LAST name, stored in clear plastic baggies.

Initial

I understand I must pay the $100 registration fee and first week's tuition to hold my child's spot. I understand that first week's tuition will be applied to the week my child is scheduled to start regardless of whether they attend. I will be responsible for enrolled weekly tuition from that point on until proper notice

Initial

I must give at least a one month notice to attendance schedule changes or withdrawal, tuition will be due until last day of notified attendance.

Initial

I understand and acknowledge that illnesses and accidents can and do occur, even with the best efforts of parents, guardians, and teachers. For instance, a child may be ill without anyone knowing, and such illness could cause more severe problems for the children or children in contact with such while at our center or in your care. As stated in parent/guardian agreement Head Heart Hands Preschool is not liable for medical or other related expenses due to accident or injury to my child. We promote a safe and healthy environment and for the school to do so, each parent must cooperate and fully inform the school of all instances of illness, accident, or other ailment of your child.

Initial

My student will be enrolled in a Primary Care Group with one teacher as a primary caregiver, that teacher will be responsible for individualized lesson plan instruction. Our infant room is a hands-on learning experience for all our infants. Redirection will be used when needed to support the learning process of our infants to foster early language skills, social/emotional skills, facilitated exploration, and creating a positive relational climate.

Initial

I,

the parent or guardian of,

a child at Head~Heart-Hands Preschool,

Videos/photographs of my son or daughter may be taken during the course of their care and may be used for informing the community of activities in which enrolled children participate. I understand that this may include activities at the church, in our community, and/or Head~Heart~Hands Preschool. These photos and videos may be used on our website or any other advertising and promotional materials. I also understand my child's personal information and/or contact information will not be utilized in these materials.

Authorize for general use For classroom use only

Initial

I understand that tuition for childcare is due regardless of attendance and I must pay for all vacation time to hold my infants spot. If my infant is enrolled full time, tuition will not be due when the center is closed for holidays (please look in parent handbook for dates we are closed Part-time students may attend on a different day if there is an open slot for that day (director will determine capacity Initial

Initial

SIDS Risk Reduction Statement: 16. Iunderstand that my infant is always put to sleep on their back, unless we have written consent from a doctor stating to do otherwise. My infant will be closely monitored while sleeping on only firm, flat crib mattresses. There will me no loose bedding, toys, or pillows in the crib with my infant. All staff members who care for infants in our facility are trained and certified in First Aid/CPR. Initial

Initial

I have read, understand, and agree to abide by the infant room specific guidelines. If I do not I could be in jeopardy of losing my infants spot in the program.

Parents/ Guardians Signature

Date

PLEASE READ THE FOLLOWING DATA PROVIDED BY THE AAP (American Academy of Pediatrics) BELOW: 1. "Sitting devices, such as car seats, strollers, swings, infant carriers, and infant slings, are not recommended for routine sleep in the hospital or at home, particularly for young infants. Infants who are younger than 4 months are particularly at risk, because they may assume positions that can create a risk of suffocation or airway obstruction or may not be able tomove out of a potentially asphyxiating situation. ("SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment" 2016) 2. "Swaddling, or wrapping the infant in a light blanket, is often used as a strategy to calm the infant and encourage the use of the supine position. There is a high risk of death if a swaddled infant is placed in or rolls to the prone position. 88, 105, 106 If infants are swaddled, they should always be placed on the back. Swaddling should be snug around the chest but allow for ample room at the hips and knees to avoid exacerbation of hip dysplasia. When an infant exhibits signs of attempting to roll, swaddling should no longer be used. 88, 105, 106 There is no evidence with regard to SIDS risk related to the arms swaddled in or out. These decisions about swaddling should be made on an individual basis,

depending on the physiologic needs of the infant. ("SIDS and Other Sleep-Related Infant Deaths: Updated2016 Recommendations for a Safe Infant Sleeping Environment" 2016) 3."Keep soft objects and loose bedding away from the infant's sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation. ("SIDS and Other Sleep-Related Infant Deaths: Updated 2016Recommendations for a Safe Infant Sleeping Environment" 2016) 4."Infants should be placed on a firm sleep surface (eg, mattress in a safety-approved crib) covered by a fitted sheet with no other bedding or soft objects to reduce the risk of SIDS and suffocation. ("SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment" 2016)

Procedures Used By Head Heart Hands Preschool

We always put infants to sleep on their back unless we have written instructions from the infant's doctor directing us to do otherwise. 2.We closely monitor sleeping infants to make certain that they are not overheated. 3.We use only firm, flat crib mattresses for infants. 4.We make certain there is no loose bedding or soft toys or pillows where the infants are sleeping. 5.We make certain that the infant's head remains uncovered during sleep. 6.Infants in our facility are supervised by a staff member at all times, even when the infants are sleeping.

All staff members who care for infants in our facility are trained in Infant CPR and have been trained to resuscitate infants if they stop breathing for any reason.

Please sign two copies of this statement in the space provided below. Return one copy to our facility and keep one copy for your own records.

We look forward to working with you to keep your infant safe, healthy, and happy.

Sincerely, Head~Heart~Hands Preschool

We, the parents of will be placed to sleep on his/her back while in care at Head~Heart~Hands Preschool.

We, the parents of

, have read this SIDS Risk Reduction Statement and understand that our baby

Print parent's name

Parent's Signature

Head ~ Heart ~ Hands Preschool

Head ~ Heart ~ Hands Preschool

ALL FORMS MUST BE FULLY COMPLETED AND SIGNED

Head ~ Heart ~ Hands Preschool

Head ~ Heart ~ Hands Preschool

MEDIA RELEASE:

Head ~ Heart ~ Hands Preschool

Head ~ Heart ~ Hands Preschool