Toddler Town Daycare Parent Intake Form

Outlined below are the steps for enrollment at both of our locations

Step 1. Complete an in person tour with your child.

Step 2. Completion of the parent intake form.

Step 3. Complete a parent interview with information received from the parent intake form.

Step 4. Determination on your child’s enrollment at Toddler Town Daycare

Step 5. Completion of your enrollment application and subsidized childcare application if needed

Step 6. Upon acceptance to Toddler Town Daycare – Scheduling your child’s probationary week Based on the answers provided below and what we see in the first week of probationary enrollment, we will base the final determination of enrollment.

*Oreintation / Probation/ trial weeks can be cancelled by the parent and or center at anytime during the probation / trial weeks. Please keep in mind that this is not guareented free childcare. This is a time to see if we are a good fit for your family and to see if our program is the program for your family.

We work very hard to make sure that our centers are going to be the best possible fit for your child and your family. Please complete and return this form prior to your child’s first day. This information, which is strictly confidential,and will help us work in partnership with you for the benefit of your child. It will enable us to be supportive and understanding as your child adjusts to our program. Thank you for the time and effort this form requires. ·

Toddler Town’s Orientation and Probationary time Policy Orientation is a time when the parents can come in, see the center and discuss the type of care that we can offer their children. It is a time for the parent to be reassured so that they know what will be going on during the day while their child is in our center. This is also a time where parents can ask questions concerning our policies.

If inquiring about our Evanston or Chicago Location the first step is to contact the enrollment specialist,

Ms. Norma. Is from our Evanston Location 847-475-1467 ext 16 / Norma@toddlertownevanston.com.

If inquiring about our Chicago Location the first step is to Contact Mr. Robert at 773-622-9433 ext. 21 or Robert@toddlertownchicago.com or Mrs, Megan at 773-622-9433 ext. 27 or at Megan@toddlertownchicago.com.

Everyone communicates with all new potential parents and usually communicates by phone and/or by email. The first email you receive from is a general email that gives information about the school, and if we have availability or not. It will also contain the link to complete the parent intake form. This form is going to ask questions about your family and your child.

This will help us determine if we will be able to meet the parents needs and expectations as well as the students. After submitting the intake form, the form will be reviewed by the Directors, and we will determine If we can start the orientation process for your child.

The orientation process will be a week,free of charge and as follows: 1st. Parent and child will tour facility· 2nd. Based on the visit with the parent and the teacher, if both parties believe the center is the right fit for their child’s growth and development, we will setup a schedule for an orientation week.

This orientation week will be for the child and teachers to get to know each other and to see if our classroom settings are beneficial to your child’s growth and development. During this week, your child is NOT enrolled, but we will still need your child’s birth certificate, health insurance, school medical and emergency contacts. Parent policy handbook will also have to be signed off on.

After the Orientation, and if we decide that the child will be enrolled, we then will move forward with the enrollment process. By this point, all we will need is the enrollment application and form of payment.

If going through Action For Children, then the Action for Children application is needed along with two most current check stubs. After your child is officially enrolled, we still have a one to two-week probationary period.

During the intake process and the one to two week probationary period you will not be charged for services.

Your actual Full Enrollment will start at Toddler Town Daycare once you have been fully enrolled and we begin Billing you with your Tuition Account and Statements. Scheduling your child’s probationary week is important.

Based on what we see in the first week of probationary enrollment, we will base the final determination of enrollment. We work very hard to make sure that our centers are going to be the best possible fit your child and for your family. This information, which is strictly confidential, will help us work in partnership with you for the benefit of your child, and it will enable us to be supportive and understanding as your child adjusts to our program.

If during this week your child promotes any behaviors that are in the following list, we then will have to create an Action plan for your child and possibly, transition your child to a different center than can meet the child’s needs. The following Behavioral list is a list of behaviors but not limmited too behaviors that will lead to a child being transitioned out or not approved at for enrollment at our center:

1. Not following routines or directions

2. Not Adjusting to our classroom setting and ratio (Requiring one on one most of the day)

3. Climbing

4. Continuously promoting aggressive behaviors towards students or teachers a.Hitting b. Biting c .Throwing furniture or toys d.Kicking e. Punching f. Slapping g. Spitting h. Head budding

5. Continuously using aggressive and or profane language

6. Frequent Uncontrollable tantrums a. Throwing self on the ground b. Throwing nearby materials c.Yelling uncontrollably for more than ten minutes

7. Damaging/Breaking school materials and furniture

8. Hurting or endangering self and others a. Dropping body on floor b.Banging head c. Sliding or dropping downstairs d.Climbing over fences or gates or areas that are unexpected and dangerous e. OPENING CLASSROOM DOORS AND SCHOOL EXITS!

During the orientation and during the probationary period, teachers will be taking observational notes daily. After the probationary time, if any of these behaviors do happen to be promoted, the center will put in place a behavioral support plan.

If the behavior that is being promoted by the child is something that we can work on, then an accommodations form will be completed for the child, teachers and parents/guardian. If the behaviors that are being promoted by the child Is something that is out of our control or that we feel will not benefit your child’s growth and development, or that may jeopardize the safety of the students and all other students, then a transition plan will be put in place.

*Probation/trial weeks can be cancelled by the parent and or center at anytime during the probation / trial weeks. Please keep in mind that this is not guareented free childcare. This is a time to see if we are a good fit for your family and to see if our program is the program for your family.

Thank you very much for taking the time to read our plan and to answer the questions below.

Toddler Town Orientation Hours

Monday to Friday (all 5 oreintation days are not guaranted)

8:00am to 3:00pm

8:00am to 4:00pm

8:30am to 3:30pm

9:00am to 4:00pm

**Hours vary by location, center enrollment, & number of orientations in progress. We cannot guarantee you any specfic hours or allow parents to chose a specfic schedule. Your Enrollment administraor will give you your schedule.

Thank you.

Signature - I have read the Orientation Steps and have also read the Orientation hours above

Which Toddler Town Location Are you Applying For?

Your Child's Full Name

First NameLast Name

Your Child's Birthday

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of Person Completing Form

First NameLast Name

Relationship to child

Home Phone Number

Please enter a valid phone number.

Work Phone Number

Please enter a valid phone number.

Cell Phone Number

Please enter a valid phone number.

Email

example@example.com

Since we only have 1 parent / guardian complete the form - We ask that you please include the 2nd parent / guardian in this section if you chose to do so. Please include all of their contact information.

Name, Address, Telephone Number and Email Address.

You can speak to the other parent / guardian about my child, this in take form, and their enrollment into your center.

Are children biological of both parents?

If not describe relationships

If your child was adopted, at what age? What does he/she know about his/her adoption

Parents Marital Status

Has your child's Pediatrician expressed any concerns for your child?

What would you hope to see happen for your child in our center?

If parents are not living together, who has legal custody of the child and what is the visitation schedule in place with the non-custodial parent?

Does either parent travel for business purposes? If so, how often?

Does anyone in the household have special needs (i.e. medical, learning, other?)

Are there any family situations that we should know about? (i.e. moves, illnesses, recent or impending death of family member of pets, other?) Please note that it is important for us to be aware of these sorts of things. Please keep us informed during the year of this sort of situation.

Describe your child's eating habits and schedule

What foods does your child like and or dislikes?

Please describe your child's sleeping/nap schedule and routine

Does your child share a sleeping space with someone or a bed someone? If so, with whom?

Does your child use a weighted blanket?

How does your child relax or soothe him/herself?

Are there specific situations in which your child become afraid, angry, withdrawn, over stimulated, uncomfortable, etc?Please describe in detail

How does your child say goodbye? How have you helped your child separate from you in previous situations?

What strategies do you use to discipline your child at home?

Is your child toilet trained?

At what age were they trained

If not trained - what process are you using?

What word does your child use for urination?

What word does your child use for bowel movement?

Does your child know how to pull clothes down and put them back on?

How many hours a day does your child watch TV or have SCREEN time (Tablet, phone, computer, etc):

Whom does your child play with at home?

Is play monitored?

What types of things do they play or engage with? Is there any type of rough play?

Does your child play with other children outside of school?

If you answered yes to the above question - what are the ages of the children that your child plays with?

Describe the type of play your child prefers (solitary, with one other child, in groups, active or passive, etc.) What are some of your child’s favorite activities?

Can your child feed him/herself using a spoon/fork?

Wash and dry own hands?

Dress him/herself independently?

Stay with a babysitter or another family member

Speak clearly so that he/she can be understood by others?

Express thoughts and needs easily?

Is your child highly active?

Is your child very calm and quiet?

Can your child settle him/herself down if needed?

Does Child Have an IEP (Individual Educational Plan)?

If your child has an IEP - please explain - * Please also upload a copy of your IEP at the end of this Intake form.

What do you find the most endearing about your child?

What do you find most challenging about your child?

What is your afternoon / evening routine like?

What is your morning routine like?

Is your child ill frequently?

Does your child have allergies?

If you answered yes, and your child requires medication or special treatment, You will need a doctor's note telling us the specifics about the allergy and possibly provide and allergy plan along with an EPI pen and or medication and the medical consent form must be completed. Does your child take any medication on a regular basis?

Describe any illness, operations, accidents or hospital stays your child may have had.

Was your child born full term or premature?

If premature at how many weeks?

Were there any complications at birth? or after birth?

Are there any health factors that you may concerned about for your child?

Do you have any concerns about your child's vision?

Does your child books and or objects close to their face?

Do you have any concerns about your child's hearing?

Has your child ever had problems with multiple ear infections?

Has your child ever had any problems or difficulty with any of the following?

Are there any diagnosed developmental issues or delays or possibility of there being a developmental delay?

Has your child received any outside services or therapies? If yes, please describe which services below and how often?

Please let us know where the services mentioned above are offered

Is your child on any waiting lists for therapy or services? If yes please let us know for what and with whom.

How does your child play with other children?

Does your child have problems getting along with other children?

Does your child like to share?

Does your child hit?

Does your child bite?

Does your child cry often?

What is your ethnic /cultural / racial background

Is your child bi-racial? How do you describe your child?

What languages are spoken at home?

If English is not your native language, how comfortable are you speaking and reading English?

Do you have cultural traditions you would like to share with your child’s teachers?

Has your child had any previous experience with play groups, nursery school, daycare, or Sunday school?

If your child was at a previous childcare center, why are you choosing to place your child in our center?

Have you ever been asked to leave a center? If yes can you please explain why?

If you answered yes to the above questions, what was the name of the center that you were asked to leave from

Can we contact your previous provider/center?

Has anyone ever expressed any concerns about your child not mentioned on this form? Please feel free to share anything you would like in this section?

If your child has an IEP (Individual Educational Plan) please upload the file here for our review.

Parent Signature for the entire form*

*Oreintation / Probation/ trial weeks can be cancelled by the parent and or center at anytime during the probation / trial weeks. Please keep in mind that this is not guareented free childcare. This is a time to see if we are a good fit for your family and to see if our program is the program for your family.

We have added this portion to this form because parents like to complain to the Department of Children and Family services and or write negative reviews on websites that all we want are the perfect classrooms if enrollment is not offered to their family, however that is far from the truth.

We work with everyone to the best of our abilities and our teachers go above and beyond to be their for all students, however their are times when we are not either equipped or able to meet the needs a family may have and we hope that parents and families understand that we are not here just to collect a paycheck every week, that we are here to actually make a positive difference in your child's life.

Orientation /Probation / Trial Weeks above statement Signature*

Thank you for taking the time to complete the Parent In Take Form. Once it is received our staff will review the form and contact you whitin 1 to 3 business days to schedule the parent interview.

Thank you.