Head ~ Heart ~ Hands Preschool

Registration Form Monday-Friday 7:00am-5:30pm Federated Church

400 W. Aspen Ave. Flagstaff, AZ 86001 (928)607-5871

Child Information - Ages 6 weeks - 12 years

Is your child potty trained?

How often do you plan to attend Head~Heart~Hands Preschool?

Has your child attended a preschool previously? YesNo

I give permission for my child named on this form to participate in the Head~Heart~Hands Preschool. I will not hold any person(s) or organization connected with the activity responsible for injuries sustained by my child in the normal course of play. I understand that the said organization does not provide medical insurance coverage for my individual child. This means that I am responsible for the medical bills if my child gets hurt. I hereby agree to accept full responsibility to pay all fees in advance as required for my child to attend.

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

1.All services require a pre-payment and I understand my child may not attend if a pre-payment has not been made by Monday of the attending week. My child may not attend until payment has been paid or arranged. In order for my child to attend, I must have a positive balance.

2. If you do not make your weekly payment by Monday close of business, 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.

3. 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. I also must check in with my child's teacher upon pick up/ drop off. I give permission for HHH Staff to sign my child in/out if leaving or returning on the bus.

4. 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.

5. 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.

6.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 the emergency card can be reached, law enforcement officials will be called to pick up my child.

7. 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. I understand I will be charged $5 administration fee if I do not sign in/out my child.

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

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

10. 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

11. 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.

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

13. 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

Head ~ Heart ~ Hands Preschool

Video/photographing of my son or daughter for the purpose of informing the community of activities in which he or she participates. I understand that this may include promotions at the church, community, or

Head~Heart~Hands Preschool website or any other advertising or promotional materials. I also understand my

child's personal information and/or contact information will not be utilized in these materials.

I understand all children will be photographed twice per year for pictures Fall and Spring.

a child at Head~ Heart~Hands Preschool, give permission for my son/ daughter to attend field trips to the

Library when field trips are planned for the year of 2018. I understand I will be notified when the trips occur, and give permission for them to attend ahead of time.

To ensure the safety and well-being of all our children and staff, we are implementing the following Behavior Policy. Staff strives to deal with children in a fair and appropriate manner. Misbehavior is redirected, and all program participants must be able to respond to verbal direction from staff. Emphasis placed upon each child taking responsibility for his/her own behavior. Participants do not Ifever have thechild thetoof,orotherchildren.aistrouble right interruptactivityhaving endanger, with another participant, they should notify a staff member for help. We are dependent upon parental support in helping us reinforce appropriate behavior. Behavioral problems will generally be approached in the following progressive manner:

1) Verbal Warning/Redirection 2) Quiet time/loss of privileges 3) Incident Form 4) Short Term Suspension 5) Expulsion

Behaviors that will result in an automatic incident form include, but are not limited to: 1. Leaving the area without permission 2. Consistently not following directions with the intention of being disruptive 3. Violating technology guidelines 4. Bullying or aggression 5. Inappropriate or abusive languages 6. Unsafe behavior (to themselves, other students and staff)

Extreme behaviors that will result in automatic suspension include but are not limited to: 1. Physical fighting, biting or any other physical harm to another student or staff member. 2. Use of sexually explicit or racially derogatory language or harassment meant to intimidate shame or haze another child or staff member 3. Stealing or Vandalism 4. Defiance or insubordination to staff

If any student receives a suspension 3 times throughout the program it may result in expulsion from the program for an amount of time to be determined by the Director. have read and understand this behavior policy:

***At no time will corporal punishment be used as a form of discipline***

Head ~ Heart ~ Hands Preschool