Application for Child Care Services

Application for Child Care Services
At which location are you enrolling?*
Enrollment Date:*

MonthDayYear
Date
Childs Full Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Gender*
Siblings names & ages
Name of responsible party
Relationship to child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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.
Responsible Party Employer Name / Location
Job Title
Email
example@example.com
Responsible Party Social Security Number
Date of Birth

MonthDayYear
Date
Our program does not exclude children with special needs, for us to provide a safe environment, the following information is required:
Previous Child Care Experience
Special Needs of Parent (inability to climb stairs, difficulty lifting child etc.)
Special Needs of Child or Conditions Requiring Special Considerations (medications, treatments, or allergies)
Food Child Likes
Elimination Patterns (toileting/diapering)
Things That Comfort Child
Things That Scare Child
Cultural Habits/Home Issues That May Affect Child’s Behavior
Who Will Care for the Child When They Are Ill and Unable to Attend School
Is there a court order effecting custody of your child? If yes, responsible party must provide Future Generation a certified copy of the court order (with the raised seal) before child can attend Future Generation.

YesNo
Authorization for Emergency Care
I authorize my child to be taken to the nearest hospital for emergency medical care. I will assume full financial responsibility for services rendered by the hospital and/or transport services.
Child’s Medial Insurance Carrier
Group #
Physician’s Name
Phone Number
Please enter a valid phone number.
Pediatric Dentist Name
Phone Number
Please enter a valid phone number.
Responsible Party Signature*

Clear
Date*

MonthDayYear
Date
Responsible Party Signature*

Clear
Date*

MonthDayYear
Date

Future Generation Parent Code of Conduct
The concept of respect is one that Future Generation bases its philosophy on and teaches every day. It is imperative that each parent understands the importance of following the Future Generation Parent Code of Conduct.

I agree that I will abide by the following rules:
- I will not engage in using profanity, physical violence, threatening gestures including but not limited to confrontational actions and inappropriate tones with any child or adult while on Future Generation grounds.
- I will be in control of my actions.
- I will respect the concept of confidentiality and understand that confidentiality protects reputations and if violated can be damaging to both adults and children.
- If I have a concern or question, I will use a Parent/Staff Communication Form to address my issues.
- While I reserve the right to discipline my child, I understand that I may not discipline other children at ANY time.
- I understand while on Future Generation grounds or field trips, I may not physically discipline my child.
- I understand that the relationship between Future Generation staff and parents needs to be kept in the professional realm. Fraternization and personal relationships/private arrangements will not be tolerated. I understand that social media is included in this policy. I will not “friend” or communicate with the staff of Future Generation on any form of social media.
- Since the consumption of nicotine, alcohol, marijuana, and other controlled substances is not permitted on Future Generation grounds, I will ensure that my child will not enter the building smelling like any of these substances.
- I understand that any infractions of these rules may result in suspension or termination of my child care services.
Full Name*
Signature*

Clear
Date*

MonthDayYear
Date

Future Generation Expulsion Policy
Future Generation is proud of our history of working with the individual needs of our children and will work with the parents whose children may need additional support. When applicable, we will make referrals to outside support services including but not limited to, early intervention, speech, occupational and physical therapy and other types of services, and participate in IEP (Individual Educational Plan) meetings where appropriate to best meet the needs of students.

Future Generation will make reasonable accommodations to their policies, practices, and procedures as appropriate in accordance with applicable federal and state laws. Future Generation is not required by law to fundamentally alter or change the services provided for a child displaying dangerous/inappropriate behavior, developmental delays and/or disabilities as defined by the Americans with Disabilities Act.

Future Generation will allow outside resources/therapists into the program to work with any child as needed, provided those services are communicated in advance, the provider of the services has the appropriate clearances to be in the building, the behavioral/therapeutic plan is shared with the administration and the resource/therapist works cooperatively with Future Generation staff to meet the needs of the child. Presence of the resource/therapist must mitigate any and all safety risks the child presents to themselves and to others and must be collaborative and complimentary to the program. Should the resource/therapist be disruptive to the program or not have the authority or ability to mitigate, through appropriate therapeutic methods, the child’s dangerous behaviors, the child may be excluded from the program.

Any child who is a safety threat to themselves or to others will be subject to suspension/exclusion and/or dis-enrollment from the program if the dangerous behavior cannot be eliminated through reasonable accommodations provided for under applicable federal and state laws and regulations.   A Tolerance Day or temporary suspension from the school may be necessary for the safety of the child or others while any appropriate evaluations are completed and/or while securing the appropriate support services from the appropriate agency.

Future Generation will at all times provide written documentation to the parents of any child that is subject to referral for outside support services for any behavior, developmental delay or disability. Further, through formal and informal conferences with the teachers and administrators, written incident and accident reports and letters, Future Generation will communicate with parents/guardians of children exhibiting behaviors that are dangerous to themselves or to others, the steps taken to accommodate the child and notification that the child will not be able to return to the program until support services are in place.

The following are causes for IMMEDIATE expulsion:

•      The child is at risk of causing serious injury to other children or themselves.

•      The breaking of the Parent Code of Conduct.

Other actions that MAY lead to expulsion after the completion of a Tolerance Day:

•      Uncontrollable tantrums or outbursts.

•      On-going physical or verbal abuse of staff or other children by the child.

•      Excessive Biting

A child will NOT be expelled if a child’s parents have:

•      Made a complaint to the Office of Licensing.

•      Reported abuse or neglect occurring at the center
Parent Full Name*
Signature*

Clear
Date*

MonthDayYear
Date

Future Generation Parent App Information Collection Form

Future Generation uses a daily parent communication software. Please fill out the information below so we can assure that your contact information is entered into our system correctly. It is your responsibility to provide the center with photographs of all parties who are authorized to remove your child from our school. Please email them to the Director.
Child's Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Classroom
Child's schedule
Primary Individuals Full Name

First NameLast Name
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Primary Individuals Full Name

First NameLast Name
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Please List Names and Phone Numbers of People Authorized to Pick Up Your Child from Future Generation:

Please email pictures of your authorized pick-ups to your Center Director.
Authorized Person 1
Authorized Person's Phone Number
Please enter a valid phone number.
Authorized Person 2
Authorized Phone's Phone Number
Please enter a valid phone number.
Authorized Person 3
Authorized Person's Phone Number
Please enter a valid phone number.
Authorized Person 4
Authorized Person's Phone Number
Please enter a valid phone number.
Please download the following parent app from your cell phone’s app store: Child Pilot

Future Generation Social Media Policy

Please read, sign, and date the following guidelines outlining Future Generation’s use of social media in the classroom and as a marketing tool.
- Future Generation may post my child’s picture on their social media site(s) for marketing purposes.
- I understand that my child’s photograph may be placed on other parent’s social networking sites when they are present in the classroom as a third party for classroom events.
- I understand that the center’s means of mass communication is via the parent communication app.
- Currently, Future Generation uses Facebook, Instagram, and our website www.fgkids.org to market to the community.
- Future Generation’s accounts are set up so that parents may “like” a post and share that “like” with friends. Commenting is not permitted.
- As stated in the Parent Code of Conduct, parents are not permitted to be “friends” with staff members of Future Generation on any form of social media. Relationships are meant to remain in the professional realm.
- As always, your respect of Future Generation’s policies and procedures is greatly appreciated and valued.
I understand and agree to abide by the above stated social media Policy. I acknowledge that failure to follow the above guidelines may compromise my child’s learning space at Future Generation.
Parents Full Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date

Future Generation Permission to Screen
During the school year, Future Generation Early Learning Centers will assist the parents in securing several services that benefit the young child. In collaboration with our local Health Department and/or resource and referral agency, the following free services if available, will be provided on site.

Hearing Screening

Dental Screening

Vision Screening

Social Emotional Skills
Permission Choice:

I give Future Generation Early Learning Centers permission to evaluate and screen my child.I do not give Future Generation Early Learning Centers permission to evaluate and screen my child.
Child's Full Name

First NameLast Name
Responsible Party Name*

First NameLast Name
Responsible Party Signature*

Clear
Date*

MonthDayYear
Date

Future Generation Food Policy
Please be advised that the following are guidelines that need to be followed when providing food to children in childcare in the state of New Jersey. Please ensure that the food you are sending from home MEETS these guidelines.
- No sugar sweetened or artificially sweetened beverages shall be served.
- No solid food shall be provided to children under the age of 6 months.
- No cow’s milk shall be provided to children under the age of 12 months.
- Whole milk is provided to children ages 12-24 months.
- Reduced fat milk is provided to children over the age of two.
- Foods that are high in solid fats, added sugars, trans fat and sodium shall be limited. *
- Foods left uneaten in a dish will be discarded.
- Unused, not served food must be discarded if not consumed within 24 hours.
- Food choices from home are encouraged to include healthy options (i.e.: fruit, meat, grains, and vegetables).
- Chips and candy are prohibited as daily snacks.
- Infants are encouraged to use spoons and fingers to feed themselves.
- Glass containers and bottles are prohibited in the center.
- Children are encouraged to drink from a cup starting at 6 months. *
- Bottles will not be prepared with anything other than formula or breast milk in them.
I have read the Future Generation Food Policy and agree to abide by the guidelines.
Full Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Application for Child Care Services

Authorization for Emergency Care

Future Generation Parent Code of Conduct

Future Generation Expulsion Policy

Future Generation Parent App Information Collection Form

Future Generation Social Media Policy

Future Generation Permission to Screen

Future Generation Food Policy