ECC Registration Packet 2025-2026

RED BRIDGE EARLY CHILDHOOD CENTER

Registration Packet
What school year is your child enrolling in? For Camp ECC, just type "Summer"
Child's Full Name*
Is your child a

New Student?Returning student?
Date of birth*

MonthDayYear
Date
Name used at School
Gender

MaleFemale
Primary address*
City*
State*
ZIP Code*
Church Home
Previous Schooling
Future Elementary School
Mother's Name*
Mother's Address (if different)

Address (if different)

Street Address Line 2

CityState

Zip
Mother's Email*
example@example.com
Mother's Cell*
Please enter a valid phone number.
Mother's Employer*
Mother's Employer Address*

Employer address

Street Address Line 2

CityState

Zip
Mother's Work Schedule *
Additional Contact Number for Mother (Work or home) *
Please enter a valid phone number.
Father's Name*
Father's Address (if different)

Address (if different)

Street Address Line 2

CityState

Zip
Father's Cell Number*
Please enter a valid phone number.
Additional Contact Number for Father (work or home)*
Please enter a valid phone number.
Father's Email
example@example.com
Father's Employer*
Father's Employer Address*

Employer address

Street Address Line 2

CityState

Zip
Father's Work Schedule*
Names and Ages of Siblings
This is a non-complete list of the possible developmental delays or medical issues. We will use this information to help us properly place your child in a classroom.
Medical information (please check all that apply)

Hearing ImpairedLanguage DelaysMedical bowel problemsDiagnosed ADD/ADHDOveractiveDiabetesAsthmaSkin diseaseInner ear problemsPhysical delaysAutismVision ProblemsHistory of bitingOther
Please explain any positive answer above:
Allergies*
Is your child (check all that apply):

Shy?Nap daily?Suck his/her thumbHave a dependance on an object?Toilet trained?Play well with others?Take a pacifier?Overactive?
Usual bedtime
Rising time
Since your child's disposition often depends on his/her home atmosphere, it is extremely helpful for us to know if your child experiences a transitory period such as divorce or death (including a pet), separation from a parent, relative or friend, illness in the family, birth of sibling, or any other information you feel would be relevant. This gives us the opportunity to provide special attention your child may need during challenging times. All information will remain confidential.
Additional information:
2's Class Options: Children must be 2 by September 1

Monday/WednesdayTuesday/ThursdayFriday
Three Year Old Classes: Children must be 3 and potty trained by September 1

Monday/WednesdayTuesday/ThursdayMonday Explorers (This class is offered in addition to the Tues/Thurs class)Wednesday Explorers (This class is offered in addition to the Tues/Thurs class)Friday Explorers (This class is offered in addition to the Mon/Wed or Tues/Thurs class)
Four Year Old/Pre-K class options:

Monday/Wednesday/FridayTuesday/Thursday/FridayMonday Explorers (This class is offered in addition to the Tues/Thurs/Fri class)Tuesday Explorers (This class is offered in addition to the Mon/Wed/Fri class)Wednesday Explorers (This class is offered in addition to the Tues/Thurs/Fri class)Thursday Explorers (This class is offered in addition to the Mon/Wed./Fri class)
High 5's class- this class is recommended for children who are 5 before Sept 1 and have completed the Pre-K class

Monday/Wednesday/FridayTuesday Explorers (This class is offered in addition to the Mon/Wed/Fri class)Thursday Explorers (This class is offered in addition to the Mon/Wed/Fri class)
Stay and Play Club: Optional extended day for children ages 3-5 years old. Children stay until 3:00pm

Monday Stay and PlayTuesday Stay and PlayWednesday Stay and PlayThursday Stay and Play
The following symptons require parental contact and the sending home of a child:

1.More than one abnormally loose stool

2.Red or blue in the face or makes high-pitched croup or whooping sounds after coughing

3.Difficult or rapid breathing

4.Yellowish skin or eyes

5.Tears, redness of eyelid lining or irritation, followed by swelling or discharge or pus (signs of (pink eye)

6.Unusual spots or rashes

7.Sore throat or swallowing difficulty

8.An infected skin patch: crusty, bright yellow, dry or gummy areas of the skin

9.Unusually dark, tea-colored urine

10. Gray or white stool

11. Fever over 99 degrees Fahrenheit

12. Headaches and stiff neck

13. Vomits

14. Contagious period of a disease

15. Severe itching of the body or scalp or scratching of the scalp which may be symptoms of lice or scables.

Please keep your child home if they have any of the above symptoms OR have had a fever, vomited or had diarrhea within 24 hours of a school day. Please notify the ECC office if your child is not feeling well and will not be attending preschool that day.

Be sure you or your emergency contact can be reached on the days your child attends ECC.
I have read all of the above information and agree with the terms stated*

Agree
Red Bridge United Methodist Church Early Childhood Center does not offer any special services such as therapy, counseling, or medical treatment. If you have a child who has a medical condition that may require emergency medication, you must provide that medication (inhaler, EpiPen, Benadryl, etc as well as a MO Medical Authorization Form, and an Individualized Plan for Children with Medical Health Concerns form. This gives the school signs and symptoms to watch for if your child has a medical emergency. It also gives the school written permission to administer the medication.

Please note: Red Bridge Early Childhood Center may be in communication and ultimately dismiss a child if the Red Bridge Early Childhood Center program cannot meet his/her needs.
I have read all of the above information and agree with the terms stated*

Agree
I hereby do/do not give consent to let my child be photographed for use by the Red Bridge United Methodist Church Early Childhood Center. The photographs may be used in the classroom, in the hallways, on our website, on our Facebook or Instagram page, or in our spring slideshow. No information that would identify my child will be included if his or her photograph is used.

I do give consentI do not give consent
Students enrolled at ECC are required to present documentation of up-to-date immunization status before attending preschool. No exemptions will be allowed. Parents must also provide a Missouri Medical form signed by a doctor before the first day of school.*

AgreeDo not agree
EMERGENCY CONTACT INFORMATION & CARPOOL AUTHORIZATION

Those who have permission to care for my child (other than parents or doctor) and who have permission to be a carpool pick-up person.
#1 Name of emergency contact*
Relationship to child*
#1 Emergency Contact phone *
Please enter a valid phone number.
Emergency Contact Address*

Address

Street Address Line 2

CityState

Zip
#2 Name of emergency contact
Relationship to child
Phone Number
Address

Address

Street Address Line 2

CityState

Zip
#3 Name of emergency contact
Relationship to child
Phone Number
Address

Address

Street Address Line 2

CityState

Zip
The following people DO NOT have my permission to pick up my child:
ACCEPTANCE OF TERMS:

1. have fully disclosed any special needs or developmental delays my child may have. For proper placement and care, this information is needed at the time of enrollment. The Early Childhood Center has the right to refuse registration if proper care and educational needs cannot be provided for the child.

2.I understand that classes may be cancelled if the minimum requirement is not met. If a class must be cancelled due to low enrollment, we will contact you by August 1.

3. I understand that I must pay one month's tuition each month by the 10th of the month or a $15.00 late fee will be charged.

4.I understand that I am required to give the office a 30-day written notice if I am going to withdraw my child from the program for any reason. I understand that am responsible for that month's tuition.

5. I understand that I must provide a signed Medical Examination Report for my child that includes his/her immunizations record. This must be on file in the office before the first day of school.

6. I understand that ECC does not transport children to any off-site locations for field trips or excursions

7. I understand that I may request notice at enrollment or any time thereafter whether there are children currently enrolled in or attending the facility for whom an immunization exemption has been filed.
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
AUTHORIZATION FOR EMERGENCY MEDICAL CARE

I understand I will be notified immediately in case of accident or injury to my child. If my child requires emergency medical care, the physician and preferred hospital to be used are:
Name and Address of Preferred Hospital*
Primary Doctor Name*
Primary Doctor Phone*
Dentist Name*
Dentist Phone*
My Insurance Company*
Insurance Policy Number*
Insurance Phone Number*
Please enter a valid phone number.
I also understand that I assume all financial responsibility for injuries sustained by my child while in the care of Red Bridge United Methodist Church Early Childhood Center.*

Agree
Please make sure all required fields have been completed before submitting.

Thank you!
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RED BRIDGE EARLY CHILDHOOD CENTER