Welcome

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Parent Info* This field is required.
First Name
Middle Name
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Email* This field is required.
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Work Phone Number
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Cell Phone Number* This field is required.
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Home Phone Number
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Address* This field is required.
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About the Child(ren)* This field is required.
Name
Age
D.O.B
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*Please list any outdoor or food allergens your child (ren) may have:
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*Please list any medications your child (ren) are currently taking temporarily or permanently:
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EMERGENCY CONTACT/PICKUP * This field is required.*Please provide all emergency contact information for your child (ren) possible in case an emergency was to occur. *Only individuals listed on this form will be authorized to pick up your child (ren) from the facility. There will be no exceptions made!
Name
Phone Number
RELATIONSHIP TO CHILD (REN)
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In the case that my emergency contact or I cannot be reached, I give my consent to allow my child to receive first aid treatment as well as consent for emergency transport should it be necessary. Also if my absence was to occur, I give permission for emergency medical treatment by emergency personnel. I understand that I will be responsible for charges not covered by insurance.* This field is required.*If Parent/Guardian becomes unable to be reached, we will contact the next available listed on your Emergency Contact/Pickup Form in case of an emergency. Please note: these contacts will only be contacted if you cannot be reached in a 911 emergency!
YESNO
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Staff, parents & volunteers Policy on the use of or possession of illegal substance, tobacco or alcohol* This field is required.We, the staff at Rita Ann’s Early Learning Academy, strive to provide a safe and healthy learning environment. With that in mind, we strictly prohibit the use of tobacco, alcohol, or any potentially toxic substance in the childcare home when children are present. It is our job as parents, staff, and family members to properly dispose of tobacco products in an appropriate receptacle before entering the home during childcare hours. If you are seen not complying with these rules and policies the staff member and/or parent or guardian will not receive service or be able to work for the facility. *THERE WILL BE NO EXCEPTIONS TO THE POLICY* NO SMOKING ON THE PROPERTY AT ANY TIME*. Everyone on the grounds of the facility including staff, volunteers, and family members present in the home will refrain from using or possessing illegal substances while on the grounds or providing care to children AT ALL TIMES! Anyone suspected of non-compliance with this policy will be asked to leave the home immediately. Staff and volunteer policy for use or possession of the illegal substance Everyone including childcare staff, volunteers, and family present in the home will refrain from possessing illegal substances while on the grounds of the home childcare facility. Anyone suspected of non-compliance with this policy will not be able to work or volunteer for Rita Ann’s Early Learning Academy. By signing this document you acknowledge you have read and
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I give permission to Rita Ann’s Early Learning Academy to take my child (ren) on field trips during regular childcare hours. I am aware that I will be notified of any planned trips ahead of time. I understand every trip will be supervised by staff members of Rita Ann’s Early Learning Academy. The staff of Rita Ann’s Early Learning Academy will follow all precautions to provide a safe environment while away from the facility. Rita Ann’s Early Learning Academy will not be responsible for any lost, stolen, or damaged property. * This field is required.
YESNO
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While attending the childcare facility during learning and playtime, I give my child (ren) permission to do the following:* This field is required.
Ride in provider’s car/van
Ride bike
Take a walk
Go to a park
Swimming
Movies
Play in sand/water
Skating
Other
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DISCIPLINE POLICY* This field is required.Dear Parents, Here at Rita Ann’s Early Learning Academy, we work with parents/ guardians of the children in my care to determine the cause of misbehavior and ways to deal with it in a positive manner. I use techniques that will allow the child time to calm down and take responsibility for his/her actions. In addition, I teach your child (ren) appropriate behavior that is used in current and future school settings. Timeouts will be utilized in my facility. There will be no scolding, threats, or bribes. My main focus is to not punish your child (ren) but to teach them how to interact socially and continually reinforce the limits in the home childcare facility. Respect for others, the environment, and themselves is expected when your child (ren) are in my care. HITTING, BITING, SCRATCHING, SPITTING, AND HOSTILE VERBAL BEHAVIOR MAY HARM STAFF OR ANOTHER CHILD WILL NOT BE PERMITTED! Each child will be disciplined individually. Consequences will occur immediately after the behavior. As a parent, I ask you NOT to punish your child at home for misbehavior shown while in my care. Please trust that I will handle the matter appropriately. Please talk with your child (ren) to assure the behavior does not continue to arise. If your child continues to misbehave, there will be procedures that I will follow to discuss the behavior with you. I WILL NOT DISCUSS PROBLEMS IN FRONT OF YOUR CHILD, CLASSMATES, OR OTHER PARENTS. If things become too disruptive, I will discuss the issues with you and try to set a strategic plan with you for the child to resolve the behavior. If this plan does not work or I receive no assistance from you, and your child (ren) continues to be disruptive, YOU WILL BE ASKED TO MAKE OTHER CHILDCARE ARRANGEMENTS! NO EXCEPTIONS! Important Note: physical punishment will not be used, even if requested by the parent/guardian. Sincerely, Katherine Adamou, Director
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PRE-SCHOOL (CCDF or Sliding Fee Scale)Part-Time Infants $40 per day Part-Time 1-2 Yrs old $35 per day Part-Time 3-5 Yrs old $40 per day ______________________________ Full-Time infants $150 per day Full-Time 1-2 Yrs old $130 per day Full-Time 3-5 yrs old $100 per day ______________________________ Saturday Care infants $45 per day Saturday Care 1-2 Yrs old $40 per day Saturday Care 3-5 Yrs old $40 per day
8 Am - 6 Pm (Part-Time)
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Infants
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3-5 yrs old
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Infants
1-2 yrs old
3-5 yrs old
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8 Am - 6 Pm (Saturday Care)
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Pyament Options* This field is required.*Please note: Cash/Electronic Payments are due the Friday prior to the week of care. Monday afternoon is the deadline for payment. Outstanding accounts will have to be paid in full prior to attendance.
Cash
Electronic Payment
Voucher
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WRAP AROUND CARE* This field is required.Rita Ann’s Early Learning Academy provides a maximum of 10 hours of care per child/per day/50 hours per week. If a caregiver/parent needs more than 10 hours per day of care; an additional fee for “Wrap Around” services is required. Rita Ann’s Early Learning Academy reserves the right to deny daily care exceeding 10 hours whereby the best interests of the child are affected. It is understood that spontaneous circumstances occur when childcare may exceed 10 hours daily; however, such situations are infrequent and not consecutive for a number of days and will not require the additional fee for “Wrap Around” services. “Wrap Around” fees will be automatically billed to your account upon occurrence. The fee is $50 per service/per week. The fees are not prorated. Arrival and departure time is maintained daily on the parent sign in/out form and on the attendance form in the classroom by teachers.
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PHOTOS/VIDEOS* This field is required.Rita Ann’s Early Learning Academy is authorized to use digital media and/or photos of my child (ren) for marketing, digital, prints, and/or social media use only promoting the activity at the facility. I am aware that there is no financial compensation in return of use of photos/digital/social media.
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CHILDCARE AND TUITION* This field is required.The custodial Guardian acknowledges that all health information pertinent to preserving the life of the scholar and to keep this scholar, staff, and peers’ safe has been disclosed to Rita Ann’s Early Learning Academy and will be disclosed in the event that new information arises at any time while the the scholar is enrolled. Custodial Guardian acknowledges that in the event that any health information that is pertinent to preserving the life of the child was not disclosed prior to the enrollment of the scholar in writing with an emergency action plan, Rita Ann’s Early Learning Academy will not assume any liability if life is jeopardized during normal business operations (i.e. meals, exposure to the sun, food allergies) due to undisclosed health information. Custodial Guardian acknowledges that in the event that a scholar is diagnosed with an illness or health impairment/condition that may affect/impede/change the care provided by Rita Ann’s Early Learning Academy after initial enrollment, the parent will provide this diagnosis/information in writing to the center with a written emergency action plan upon awareness of health impairment/condition. The custodial Guardian is aware that failure to properly inform Rita Ann’s Early Learning Academy in writing with health-related information may jeopardize the preservation of the child’s life and Rita Ann’s representatives’ ability to provide adequate care for the child. The child must be symptom-free for 24 hours before returning to daycare. In the case the daycare provider(s) become ill to the point of closure parents will be notified immediately! Alternative care for the day will be recommended without any fees being assessed for that day(s). Parent-Teacher Conferences will be held quarterly. The children will be observed and assessed every 3 months to monitor development. During the scheduled conference parents and teachers will evaluate the child’s(drens) growth and adjust lesson plans accordingly. The custodial Guardian is responsible for the full fee in the event that a tuition subsidy program doesn’t pay the full expected fee for any reason. All custodial guardians are required to sign scholars in and out when they arrive and depart from the center daily. At the end of every year tax statements for childcare are available upon request and are mailed out upon request by January 31st annually.
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ATTENDANCE POLICY* This field is required.Please read and initial beside each item AND sign your name below to confirm that you know, understand, and will comply with this policy. If a parent doesn’t sign this policy, the scholar will not be enrolled in this facility and/or withdraw effective 12/15/19. All co-pays are due Friday the week prior to service. If your co-pay is not paid by Tuesday morning, a $10 late fee will be applied to the co-pay. If the tuition balance including the late fee is not paid in full by Wednesday morning, your child cannot return until the copay and late fees are paid in full. Tuition balances cannot exceed $25.00 and payment arrangements can only be made with the Director. The agreement must be signed by the parent and Director. If payment arrangements are violated, the agreement will be terminated and the child is in jeopardy of possible withdrawal. All families must sign/check their child in and out each day. It is the responsibility of the Custodial Caregiver to make sure your representative does this when picking up the child on their behalf. Please note: our facility is 24-hour care. However, children not enrolled in “Wrap Around” Care or written arrangement must be picked up by 6 PM each day. There will be a late fee of $25 starting at 6:05 PM. Each minute after that will add $1 to the balance due. Late fees must be paid in full by the end of the following business day or the child may not return until arrangements have been made. Families that pay out-of-pocket and/or not on an approved government program (CCDF, On My Way Pre-K, etc....) are allowed 10 days of unpaid vacation days. Days must be pre-scheduled and submitted in writing to the Director at least 1 week prior to the suggested scheduled date(s).
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POTTY TRAINING POLICY* This field is required.Rita Ann’s Early Learning Academy is a place for your child to grow, and expand their minds and learning abilities. All little people will have their bridge to cross called “potty time”. I am excited to conquer this journey with your child(ren). No child will be spanked or made fun of for any accidents he or she may have. Your child WILL NOT BE PUNISHED OR PUT IN TIME OUT for any potty accidents. I know that negative feedback is not a healthy way to encourage the child. Independence and positive feedback is highly encouraged for the child. During this time it is important for the children to have everything on the list to make this very easy on our staff and of course your child(ren): SHIRT PANTS UNDERWEAR (MORE THAN ONE PAIR PLEASE) OR PULL-UPS SOCKS Any soiled clothing will be put in a plastic bag and sent home with the child’s parent/guardian at the end of the days. Rita Ann’s is not allowed to wash any clothing. This is why it is important for you to make sure your child has proper attire to finish the day. You will have to be interrupted during your busy day to bring these items. Your child's clothing will not be hand washed. PLEASE MAKE SURE YOUR CHILD (REN) ARE PROPERLY PREPARED FOR THE DAY WHEN DROPPING THEM OFF AT THE FACILITY. THANK YOU! Katherine Adamou, Director
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WRITTEN EMERGENCY PLAN (WEP)* This field is required.THE PROCEDURE FOR NOTIFYING PARENTS IN THE EVENT OF THE PROVIDER’S ILLNESS: In the event of the provider’s illness, staff or a household member will notify all parents by phone, email, or text of the provider's illness. If all staff were to become ill, parents would be notified immediately. Parents would be prepared and asked to have backup care at the beginning of enrollment. In the case of an illness, backup care will be used until the issue is resolved. If the parent doesn’t have backup care, there are resources I can provide to assist with the search. Also parents can visit www.childcareanswers.com for further assistance. THE ILLNESS OF A MEMBER OF THE HOUSEHOLD WHO MAY BE CONTAGIOUS TO OTHERS: Rita Ann’s Early Learning Academy is a home. As a provider, I will follow the same safety precautions as I would an ill student in my care. If a member of the household becomes contagious, he or she would stay in a separate location from the children attending the facility that day. If the member is notified by a physician, unsafe to be around other children or staff, parents will be notified immediately. PLANS IN THE EVENT THAT PREVENTS THE CHILDREN FROM BEING CARED FOR IN THE PROVIDER’S HOME: If a disaster was to suddenly occur and structural damage was to happen to the home, every parent will be contacted and asked to pick their child (ren) up immediately. If the disaster makes it an unsafe environment for the children and staff, the shelter will be taken at the closest hospital or fire station. Our designated hospital is Community East Hospital. Their phone number is Phone: (317) 962-2000. Our designated fire station is #10. Their address is 2970 N. Sherman Drive, Indianapolis, IN 46218. The phone number for this facility is (317) 327-6041. If the climate and area are safe for children to remain near the facility until parents arrive, we will be at the beginning of the subdivision. A BACK-UP PLAN THAT THE PROVIDER WILL ARRANGE IN THE EVENT OF AN EMERGENCY: Staff or household members are available to assist the provider in the event of an emergency. The provider, the staff, or a household member will notify parents of all emergencies as they are considered emergencies. If the parent isn’t reachable, your child’s pick-up list will be referred to and used to make proper arrangements. Anyone picking up the child (ren) in the event of an emergency must have a valid state ID. If we must leave our location, Community East Hospital is our safe location.
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WRITTEN EMERGENCY PLAN (WEP)* This field is required.IN THE EVENT YOUR CHILD (REN) BECOMES ILL OR THE PROVIDER IS UNABLE TO PROVIDE CARE FOR YOUR CHILD (REN): Parents should always have their reliable backup provider on standby in case of an emergency. Yes, parents have to work, but must also consider the health and safety of ALL CHILDREN ATTENDING Rita Ann’s Early Learning Academy. If your child (ren) becomes ill, please prepare to have a backup. If you don’t have a safe and trustworthy back-up on standby, please keep him/her home until a doctor states it is safe for your child to be able to attend childcare again. If your child is sent home, he/she may not return until a doctor’s note is present stating that the child IS NO LONGER CONTAGIOUS. NO EXCEPTIONS WILL BE MADE TO THIS POLICY!! This assures that our staff is healthy to provide a great learning environment for all children and that the virus is contained, cured, and not spread. By signing this form, you understand that you have read over the policy carefully and you are well aware of the actions that will be taken. No exceptions will be made to this form. The parent/guardian will be provided a copy of this form along with a handbook to accompany other rules and policies. A signed copy of this form will be kept in your child’s file.
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WRITTEN EMERGENCY PLAN (WEP)* This field is required.TORNADO: staff will move the children to the lowest part of the home. Staff and children will do the following: Kneel Bend down Cover head with hands After the area is checked out by staff and assured clear and safe, parents or 2nd contact will be notified immediately. EARTHQUAKE: in the case of this disaster were to occur the following will be done to protect the staff and children: Children and staff will be put up against an inside wall near anything falling Drop Cover Hold on to each other After the area is checked out by staff and assured clear and safe, parents or 2nd contact will be notified immediately. FLOOD: in case of a flood in or around the home, we will evacuate to our safe location if enough warning is available. If not, we will seek higher ground and call for help immediately. Water, canned food, can opener, radio, flashlights, batteries, first aid kits, blankets, and cell phone with parent’s phone numbers and one emergency contact will be on hand. FIRE: in the case of a fire in or around the home we will evacuate to the lot across the street to wait for the Fire Department and parents to pickup. If a disaster were to occur, PARENTS PLEASE PICK YOUR CHILD UP AS SOON as POSSIBLE OR NOTIFIED. THIS IS IN THE BEST INTEREST OF ALL CHILDREN, AS WELL AS STAFF. OUR FOCUS IS TO KEEP EVERYONE SAFE. *I, THE PARENT, HAVE READ AND ACCEPTED THE WRITTEN EMERGENCY PLAN SET BY RITA ANN’S EARLY LEARNING ACADEMY.
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