TLC Early Learning Enrollment Form 22-23

EARLY LEARNING
NEW STUDENT ENROLLMENT FORM ACADEMIC YEAR 2022-2023
Class determined by age of child on Aug. 1, 2022

(Scholarships available upon request)

2.5/3 year-old Class (F 8:30-11:30) ($50) DOB: 8/1/19 - 7/31/20

3/4 year-old Class (M/T/W 8:30-11:30) ($150) (Mostly Potty-trained) DOB: 8/1/18 - 7/31/19

4/5 year-old Pre-K Class (M/T/W/Th 8:30-11:30) ($180) DOB: 8/1/17- 7/31/18

4/5 Pre-K Class (M - F 8:30-11:30) ($205) DOB: 8/1/17- 7/31/18

A NON-REFUNDABLE ENROLLMENT FEE OF $60 IS DUE UPON REGISTRATION.

SPACE IN EACH CLASS IS LIMITED. (Your child will not be placed in a class until the fee is paid)
Class Choice - Choose 1 *

2.5/3 year old class (Friday) DOB: 8/1/19 - 7/31/20) 3/4 year old class (M-W) DOB: 8/1/18 - 7/31/19) 4/5 year old Pre-K class (M-Th) DOB: 8/1/17-7/31/18 4/5 year old Pre-K class (M-F) DOB: 8/1/17-7/31/18
Will your child be attending kindergarten during the 2023-2023 school year?

Yes No
Child's Name *

First Name Last Name
Preferred Name
Gender *

Female Male
Date of Birth *

Month Day Year
Date
Preferred Phone *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mother's Name *

First Name Last Name
Occupation
Mother's Cell Phone *
Mother's Email *
example@example.com
Father's Name *

First Name Last Name
Occupation
Father's Cell Phone
Father's Email - include if he is to receive communication from the school
example@example.com
Mother resides with child

Yes No
Father Resides with child

Yes No
Sibling Name
Sibling Age
Sibling Name
Sibling Age
Sibling Name
Sibling Age
Sibling Name
Sibling Age
Allergies (food, insects, etc.) *
Health issues (asthma, etc.) *
Fears *
Do you currently have a home church

yes no
If yes, please list
Parent/Guardian Signature *

Clear
Date *

Month Day Year
Date
PLEASE MAIL OR RETURN COMPLETED APPLICATION and ENROLLMENT FEE TO:

TLC Early Learning 1801 N. Main St Auburn, IN 46706
Child's Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
EMERGENCY CONTACTS

(List in order to be contacted after contacting parents. Do NOT list parents)
1. Contact Name *
Phone # *
Relationship to child *
Do you give permission for your child to be released to this person? *

Yes No
2. Contact Name *
Phone # *
Relationship to child *
Do you give permission for your child to be released to this person? *

Yes No
3. Contact Name *
Phone # *
Relationship to child *
Do you give permission for your child to be released to this person? *

Yes No
AUTHORIZED PERSONS TO PICK UP A CHILD

Your child will only be allowed to leave with the persons listed below. Include parents' names too. If someone is going to pick up that is not listed, you will need to send a signed note to the school.
Name of Authorized Pick-up person *
Relationship to child *
Name of Authorized Pick-up person *
Relationship to child *
Name of Authorized Pick-up person
Relationship to child
Name of Authorized Pick-up person
Relationship to child
TLC EARLY LEARNING AUTHORIZATION AND CONSENT FORM

Please read and initial each section and then sign at the bottom of the section.
MEDICAL AUTHORIZATIONS
1. I authorize the TLC Early Learning teachers who are trained in First Aid and CPR to give my child first aid and medical attention when appropriate.

2. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the TLC Early Learning or Emergency Medical Response personnel to transport my child to the nearest medical facility for necessary medical treatment for my child.

3. I will supply the school with current physical and current vaccination records within 30 days of starting school.
Child's Physician's name *
Phone Number *
Parent Initials *

Clear
PARENT NOTICE
I understand that this childcare ministry (TLC Early Learning, Auburn, IN) is not licensed under the laws of Indiana. However, I understand that this childcare ministry must comply with the state rules concerning sanitation and fire safety for the primary use of the structure in which it is conducted. I understand that it is my responsibility to ensure that the nutritional and health needs of my child are met while my child is at the childcare ministry. This notice does not absolve a childcare ministry from liability for injury to a child while the child is at the childcare ministry if the cause of the injury is negligence or intentional wrongdoing on the part of the childcare ministry or an employee of the childcare ministry.
Parent Initials *

Clear
TUITION PAYMENT POLICY
Tuition payments for TLC Early Learning are due on the 5th day of each month. Any payment received after the 5th day is subject to a late fee in the amount of $10.00. All payments are to be placed in the drop box outside the school office or paid through HiMama. Please make all checks payable to TLC Preschool.
Parent Initials *

Clear
SAFE TRANSPORTATION OF FOOD RESPONSIBILITY
Food must be brought to the facility in clean, insulated, sanitizable containers which keep food at 41 Degrees F or below and hot food at 135 degrees F or above. Containers must be clearly labeled with the child's name and date of preparation. Upon receiving the food, the facility shall verify the temperature of the food. When potentially hazardous food temperature is not correct, the facility will not accept the food. Upon accepting the food, the facility shall maintain the correct food temperature until served. By signing I take full responsibility for the safety of my child's food during preparation, storage, and transportation to the facility. Parent Initials:
Parent Initials *

Clear
TLC EARLY LEARNING ON-PROPERTY PERMISSION SLIP
I give permission for my child to explore and go for walks and nature hikes on school property and Greenhurst Commons with the TLC Early Learning staff. Parent Initials:
Parent Initials *

Clear
PUBLICITY RELEASE
I give permission for my child's picture to be released for publicity purposes through the church newsletter, local newspaper, and social media. *

Yes No
Parent Initials *

Clear
POLICY AND PROCEDURES PARENT HANDBOOK
I/We have read the "Parent Handbook". By signing below, I/We are agreeing to abide by the policies and procedures within. Handbook can be accessed at the preschool website on the Resource Page.
Parent/Guardian Signature *

Clear
Date *

Month Day Year
Date
TLC EARLY LEARNING DISCIPLINE/GUIDANCE POLICY
TLC seeks to foster a caring environment in the classroom that is conducive to the education of all children present. It is very important a child's development is nurtured through caring, patience, and understanding. However, while caring for your children, we may have to respond to your child's misbehavior. Hitting, kicking, spitting, hostile verbal behavior, and other behaviors which will hurt another child are not permitted.

In response to misbehavior, we will:
- Respect the child
- Establish clear rules and be consistent in enforcing rules
- Remove the child from the situation and talk to him or her about the behavior
- Use positive language to explain desired behavior
- Speak calmly while bending down to your child's eye level
- Redirect your child to a new activity
- If the behavior continues, the child can sit with the Director until they calm down.
- If the child cannot calm down after a reasonable amount of time, the parents will be called.
In response to these behaviors, we will not use:
- Threats or bribes
- Physical punishment, even if requested by the parent
- Deprive your child of food or other basic needs
- Humiliation or isolation
Recurring disciplinary problems will be addressed with parents and documented in the child's record. In extreme cases, a child who is habitually disruptive to the class and whose behavior has not improved satisfactorily may be suspended or expelled from the school for the remainder of the school year.

As a parent, you may have some concerns or wish to offer suggestions. Using the lines below, we may modify the above plan with agreed-upon suggestions.
Child's Name *
Date of Birth *

Month Day Year
Date
Additional techniques to be used with my child:
Parent/Guardian Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

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EARLY LEARNING

NEW STUDENT ENROLLMENT FORM ACADEMIC YEAR 2022-2023

AUTHORIZED PERSONS TO PICK UP A CHILD

TLC EARLY LEARNING AUTHORIZATION AND CONSENT FORM

MEDICAL AUTHORIZATIONS

PARENT NOTICE

TUITION PAYMENT POLICY

SAFE TRANSPORTATION OF FOOD RESPONSIBILITY

TLC EARLY LEARNING ON-PROPERTY PERMISSION SLIP

PUBLICITY RELEASE

POLICY AND PROCEDURES PARENT HANDBOOK

TLC EARLY LEARNING DISCIPLINE/GUIDANCE POLICY