Preschool Enrollment Package

SoulShine Preschool Enrollment 2023

Please complete and sign all documents below.
EMERGENCY CONTACTS AND RELEASE AUTHORIZATIONS
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Which SoulShine Campus is your child enrolled in? *
Will your child be an infant (12 months or under) when attending SoulShine Schools?*

YesNo
Has this child been enrolled previously, seeking a transfer, or seeking enrollment for the first time?*

New enrollmentPreviously enrolledSeeking a location transfer
Please note which location you wish your child to be transferred from and which on you wish to be transferred to.
Emergency Contacts

List the persons to be contacted when parent or guardian cannot be reached
First Name Last Name Phone Number (ONLY) Relationship Street Address Address Line 2 City State Zip
First Name Last Name Phone Number (ONLY) Relationship Street Address Address Line 2 City State Zip
Person #2: Include Name, Address, Phone, Relationship to Child, Relationship to Parent or Guardian, other Identifying Information.
Person #2: Include Name, Address, Phone, Relationship to Child, Relationship to Parent or Guardian, other Identifying Information.
Parent #1 Printed Name*
Parent #1 Signature*

Clear
Parent #1 Today's Date*

MonthDayYear
Date
Parent #2 Printed Name
Parent #2 Signature

Clear
Parent #2 Today's Date

MonthDayYear
Date

Person #3: Include Name, Address, Phone, Relationship to Child, Relationship to Parent or Guardian, other Identifying Information.
Release Authorization
The child may be released to the parents/guardians OR to additional person(s):*

Release to parents/guardians only.Release to parents/guardians OR to additional persons.
Person #1: Include Name, Address, Phone, Relationship to Child, Relationship to Parent or Guardian, other Identifying Information.*
CHILD PRIVACY INSTRUCTIONS
Child's Name*
Date of Birth*

MonthDayYear
Date
CHOOSE FROM THE TWO OPTIONS BELOW:

OPTION 1: GRANT CONSENT

I hereby give my consent to SoulShine Preschool to include my child/children in any photo taken for any reason within the school:
- Brightwheel updates
- Parent-Only newsletter reports
- Facebook posts (on the public Facebook page)
- Parent Portal
- Occasional marketing photos (for website or print publications like brochures)
I release SoulShine from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below.
OPTION 2: WITHHOLD CONSENT

I DO NOT consent to SoulShine Preschool including my child in a recognizable way in any photo taken for any reason within the school:
- Brightwheel updates
- Parent-Only newsletter reports
- Facebook posts (on the public Facebook page)
- Parent Portal
- Occasional marketing photos (for website or print publications like brochures)
I understand I will still receive written status updates in Brightwheel, but that images will not be part of my updates.
Child Privacy Consent*

I / We Grant ConsentI / We Withhold Consent
Parent/Guardian Name*
Today's Date*

MonthDayYear
Date
Signature*

Clear
The above child privacy instructions also apply the following siblings:
Sibling Name
Age
Sibling Name
Age
Sibling Name
Age

CHILD MEDICAL INFORMATION FORM
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Please provide a copy of the front and back of your child's insurance card:"*

Cancelof
Child's Physician or Clinic Name, Address, Phone Number*
Do you currently have your child's required immunization record (or religious/court waiver)?*

Yes, and I will upload a picture of it below.No, but I understand I will need to provide a copy in order to attend.
File Upload: Immunization Record (or religious/court waiver)

Cancelof
ANY ALLERGIES*
MUST WRITE NONE, IF NONE KNOWN
Attach any action plan from your physician required for allergic reactions listed above:

Cancelof
My child has the following special needs:*
MUST WRITE NONE, IF NONE KNOWN
The following special accommodations may be required:
PLEASE NOTE SPECIAL ACCOMMODATIONS THAT MAY BE REQUIRED TO MOST EFFECTIVELY MEET THE CHILD'S NEEDS WHILE AT THE PRESCHOOL
TOPICAL OINTMENT & PREPARATIONS: I give SoulShine Schools permission to dispense the checked topical ointments or preparations to my child in accordance to the directions on the label:*
PLEASE NOTE ANY MEDICATION(S) YOUR CHILD IS PRESCRIBED FOR LONG-TERM CONTINUOUS USE AND/OR HAS THE FOLLOWING PRE-EXISTING ILLNESSES OR HEALTH CONCERNS (IN ADDITION TO ANY ALLERGIES NOTED ABOVE).

EMERGENCY MEDICAL AUTHORIZATION
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Should my child listed above suffer an injury or illness while in the care of SoulShine Preschool and they are unable to contact me (us) immediately, it shall be authorized to secure such medical attention and care for the child as may be necessary. I (We) First Name* Last Name* shall assume responsibility for payment for services.
SOULSHINE PRESCHOOL MEDICAL EMERGENCY POLICY

In the event of a medical emergency, SoulShine Preschool will attempt to contact the parents and/or designated emergency contact persons. If these individuals cannot be reached, "911" will be called in order to have the most immediate medical help available for the needs of the child. If a contacted individual cannot pick up the child, and there is a medical emergency, SoulShine Preschool will release the child to the paramedics. A staff person will accompany the child and paramedics to Children's Healthcare of Atlanta (Egleston Hospital).
Signature*

Clear
Todays' Date*

MonthDayYear
Date

WITHDRAWAL TERMS ACKNOWLEDGEMENT

UPDATED 1/3/2022
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Sibling's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Sibling's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Sibling's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
FOUR WEEKS’ NOTICE REQUIRED TO WITHDRAW OR CANCEL

A minimum of four weeks’ written notice is required to withdraw your child or cancel a reserved position. Notify us by emailing DIRECTOR@makeyoursoulshine.com.

If notice is not given, then you will be charged tuition for each week up to four weeks. The last day of enrollment must fall on the last day of the week of the fourth week. This applies even if your child is not attending. If you decide not to bring your child to SoulShine Preschool after you have accepted a confirmed classroom space, you must provide four weeks’ notice of cancellation or pay equivalent tuition up to four weeks. There will be no exception to the requirement for four weeks’ notice.

Transitioning to Summer Camp

Many of the 4-year old students who are heading to PreK or Kindergarten each fall choose to move to a SoulShine Summer Camp for the summer, instead of remaining in the Preschool. Parents must be aware that, even though they are transitioning to another SoulShine program, the four weeks’ notice of withdrawal is still required. Registration for Summer Camp cannot serve as notice of withdrawal.

WITHDRAWAL REQUEST

I understand the withdrawal policy defined by SoulShine and agree to be bound by said policy. I attest that I am the parent or legal guardian of the child(ren) listed above.
Parent/Guardian Name*

First NameLast Name
Signature*

Clear
Today's Date

MonthDayYear
Date

SAFE SLEEP PRACTICES POLICY

ONLY required for infants under 12 months.
Infant's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
1) Infants will be placed on their backs in a crib to sleep unless a physician’s written statement authorizing another sleep position for that infant is provided. The written statement must include how the infant shall be placed to sleep and a time frame that the instructions are to be followed.

2) Cribs shall be in compliance with CPCS and ASTM safety standards. They will be maintained in good repair and free from hazards.

3) No objects will be placed in or on the crib with an infant. This includes, but is not limited to, covers, blankets, toys, pillows, quilts, comforters, bumper pads, sheepskins, stuffed toys, or other soft items.

4) No objects will be attached to a crib with a sleeping infant, such as, but not limited to, crib gyms, toys, mirrors and mobiles.

5) Only sleepers, sleep sacks and wearable blankets provided by the parent/guardian and that fit according to the commercial manufacturer’s guidelines and will not slip up around the infant’s face may be worn for the comfort of the sleeping infant.

6) Individual crib bedding will be changed daily, or more often as needed. Bedding for mats will be laundered daily or marked for individual use. If marked for individual use, the sheets must be laundered weekly or more frequently if needed.

7) Infants who arrive at the center asleep or fall asleep in other equipment, on the floor or elsewhere, will be moved to a safety-approved crib to sleep.

8) Swaddling will not be permitted, unless a physician’s written statement authorizing it for a particular infant is provided. The written statement must include instructions and a time frame for swaddling the infant.

9) Wedges, other infant positioning devices and monitors will not be permitted unless a physician’s written statement authorizing its use for a particular infant is provided. The written statement must include instructions on how to use the device and the time frame for usage.

I acknowledge that SoulShine Schools has advised me of the safe sleep practices followed by the facility.
PARENT(S)/GUARDIAN(S)NAME:

First NameLast Name
PARENT/GUARDIAN SIGNATURE

Clear
Today's Date

MonthDayYear
Date

PARENTAL AGREEMENTS
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
SoulShine Schools agrees to provide child care for the days my child, whose name and date of birth are listed above, attends Monday through Fridays, 7:30am - 6:00pm from January to December.
My child will participate in the following meal plan (check all applicable meals and snacks):

BreakfastLunchAfternoon Snack
Before any medication is dispensed to my child, I will provide a written authorization (SoulShine’s Authorization to Dispense Medication form), which includes: date; name of child; name of medication; prescription number, if any; dosages; date and time of date medication is to be given. Medication will be in the original container with my child’s name marked on it.

My child will not be allowed to enter or leave the facility without being escorted by the parent(s), person authorized by parent(s), or facility personnel.

I acknowledge it is my responsibility to keep my child’s records current to reflect any significant changes as they occur, e.g., telephone numbers, work location, emergency contacts, child’s physician, child’s health status, infant feeding plans and immunization records, etc.

SoulShine Schools agrees to keep me informed of any incidents, including illnesses, injuries, adverse reactions to medications, etc., which include my child.

SoulShine Schools agrees to obtain written authorization from me before my child participates in routine transportation, field trips, special activities away from the facility, and water-related activities occurring in water that is more than two (2) feet deep.

I authorize SoulShine Schools to obtain emergency medical care for my child when I am not available.

I have received a copy of the Parent Handbook and agree to abide by the policies and procedures for SoulShine Schools.

I understand that SoulShine Schools will advise me of my child’s progress and issues relating to my child’s care as well as any individual practices concerning my child’s special needs. I also understand that my participation is encouraged in facility activities.
Print Parent/Guardian #1 Name*

First NameLast Name
Parent/Guardian #1 Signature*

Clear
Print Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Signature

Clear
SoulShine Administrator Signature

Clear
Should be Empty:

SoulShine Preschool Enrollment 2023

EMERGENCY CONTACTS AND RELEASE AUTHORIZATIONS

Emergency Contacts

Release Authorization

CHILD PRIVACY INSTRUCTIONS

CHILD MEDICAL INFORMATION FORM

EMERGENCY MEDICAL AUTHORIZATION

WITHDRAWAL TERMS ACKNOWLEDGEMENT

SAFE SLEEP PRACTICES POLICY

Infant Feeding Plan

PARENTAL AGREEMENTS