ADLC Student Enrollment Form

ALL DAY LEARNING CENTERS

170 Township Line Road, Building B Hillsborough, NJ 08844
Welcome!

Thank you for choosing our school for your child's early education. Our goal is to provide you with the very best experience so that you may have the peace of mind knowing your child is receiving unsurpassed education and care.

Please find your enrollment documents in this packet. Complete and return all paperwork to the front desk at the main building a week before your child's first day of school.

*If your child has a food allergy, asthma, seizure or any other medical action plan please get the proper documents from your child's pediatrician and return to us with your enrollment packet.

Text Messaging
It is important that all parents of the school are registered to receive our text messages as they will be one of the primary ways we communicate with you regarding weather related emergencies as well as delayed openings, school closures and school events.

*Please text "adlc", and your first and last name, to 24587 to sign up.

Website Resources
Please refer to our website www.alldaylearningcenters.com frequently for information on our school and its current events.

The site contains information on upcoming school events, emergency response procedures, as well as the lunch software, webcams, important forms and the parent handbook, which provides vital information for parents.

We are looking forward to seeing you!
Melinda Rushing, Executive Director/Owner
STUDENT ENROLLMENT FORM
Date of Enrollment*

MonthDayYear
Date
Start Date*

MonthDayYear
Date
Child's Name*
Sex*
Date of Birth*

MonthDayYear
Date
Address*
Please check your desired full day schedule*

Monday, Wednesday, Friday (Part time)Tuesday, Thursday (Part time)Monday, Tuesday, Wednesday, Thursday, Friday (Full time)
Mother's Name*
Mother's Cell Phone*
Mother's Email*
example@example.com
Mother's Occupation
Mother's Place of Business
Mother's Business Phone
Father's Name*
Father's Cell Phone*
Father's Email*
example@example.com
Father's Occupation
Father's Place of Business
Father's Business Phone
Does your child have any siblings? Ages?*
Is there anything unique or specific you would like for us to know about your child?
Child's Doctor*
Phone Number*
Does your child have any know medical conditions? If so, please explain below.*
Is your child on any medication? Please Describe.*
Does your child have any allergies? If so, please explain*
How did you hear about us?*
Parent/Legal Guardian Signature*

Clear
PICK UP AUTHORIZATION FORM
Child's Name*
*I authorize the following people, besides myself or other parents, to pick up my child from the center in the event I am not able to do so myself.
First and last name*
Relation to child*
Phone Number*
First and last name
Relation to child
Phone Number
NO ONE OTHER THAN A PARENT OR GUARDIAN MAY PICK UP MY CHILD

YES
NO ONE OTHER THAN A PARENT OR GUARDIAN MAY PICK UP MY CHILD
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
EMERGENCY CONTACT FORM
Child's Name*
Date of Birth*

MonthDayYear
Date
Mother's Name*
Mother's Cell Number*
Mother's Work Number
Father's Name
Father's Cell Number*
Father's Work Number
Emergency Contacts other than parents:
Name*
Relation to child*
Phone Number
Name
Relation to child
Phone Number
Please note anything else we should be aware of to help us best take your of your child*
EMERGENCY MEDICAL TREATMENT CONSENT
Student*
Date of Birth*

MonthDayYear
Date
CONSENT FOR MEDICAL TREATMENT
In the event of illness or injury, I hereby authorize All Day Learning Centers (ADLC) staff with current first aid certification to administer first aid to my child, and I hereby authorize ADLC staff, or other employees of ADLC, to obtain emergency medical treatment for my child as deemed necessary, including administration of an anesthetic or other medication and surgery, and I hereby assume the cost of such treatment. Iunderstand that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but it is given to provide authority and power on the part of ADLC to give specific consent to the diagnosis, treatment, or hospital care which in the best judgement of a licensed physician is deemed advisable. I understand that ADLC will make best efforts to notify me immediately should emergency treatment for my child become necessary.

RELEASE AND HOLD HARMLESS AGREEMENT
As part of the consideration for my child's participation in ADLC activities, I hereby release, hold harmless, and forever discharge ADLC, and all of its employees from any liability, claims, demands, actions, and cause of action whatsoever arising out of or related to any loss, property damage, or personal injury, including death, that may be sustained by me or my child or to any property belonging to me or my child while my child is enrolled in the school, except for damages caused by negligence of the school, and its employees. I assume full responsibility for any risk of loss, damage, or personal injury, including death, and for any property damage that may be sustained by me or my child as a result of my child's participation in ADLC activities.

PARENT/LEGAL GUARDIAN ACCEPTANCE
I have read and I understand this document, including the release and hold harmless portions of it.
Printed Name of Parent/Guardian*
Signature*

Clear
Date*

MonthDayYear
Date
Request for Webcam Access
We are pleased to offer the parents of our students a webcam service. The system uses the latest generation of cameras, provides high resolution video, and of fers excellent security features for the school.

Fee for access will be $25 per month per sign on account for parents of currently enrolled students.

If interested, please complete and return this form.
Child's Name
Parent Name
Email address for Webcam access
example@example.com
Parent Statement and Agreement
I request access to the ADLC webcam system. I will include $25 per month with my monthly tuition. If I am not happy with the webcam system, I may terminate my access to the system, with written notice, prior to the 1st of any given month. For security reasons, I will not share access codes, pictures, or video with anyone other than the child's parent/legal guardian.
Parent Signature

Clear
Date

MonthDayYear
Date
Deposit Requirement
A non-refundable deposit of $150 is required to guarantee a spot for your child. I acknowledge the receipt of this policy.
Parent/Guardian Initials*
Parent Receipt of Information
I have received via email the handbook with the information listed below. I hereby agree to abide by the terms and conditions contained within.

-Parent Handbook

-Information to Parents Document

-Policy on the Release of Children

-Positive Guidance and Discipline Policy

-Policy on Methods of Parental Notification

-Policy on Communicable Disease Management

-Expulsion Policy

-Policy on the Use of Technology and Social Media

-Policy on Coronavirus Policies and Procedures
Child's Name*
Parent/Guardian Name*
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

ALL DAY LEARNING CENTERS

STUDENT ENROLLMENT FORM

PICK UP AUTHORIZATION FORM

NO ONE OTHER THAN A PARENT OR GUARDIAN MAY PICK UP MY CHILD

EMERGENCY CONTACT FORM

EMERGENCY MEDICAL TREATMENT CONSENT

Request for Webcam Access

Deposit Requirement

Parent Receipt of Information