Oak Brook School Allen Enrollment Paperwork

Child Information
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Child's Gender*

MaleFemale
Child's Address*

Street Address

Street Address Line 2

CityState

Zip Code
With whom does the child live?*
What days and hours will your child be in care?*
Start date*

MonthDayYear
Date
Medical History
Please list any special needs or problems your child may have, such as allergies, existing illness, previous serious illness, injuries during the past 12 months, any medications prescribed for long long-term use, and any other information that staff should know of.
Food Allergies
Requires a Food Allergy Emergency Plan
Dietary Restrictions
(e.g. vegetarian)

Parent/Guardian Information
Parent/Guardian #1 Name*

First NameLast Name
Parent/Guardian #1 Email *
example@example.com
Parent/Guardian #1 Cell Phone Number*
Please enter a valid cell phone number.
Parent/Guardian #1 Place of Employment *
Parent/Guardian #1 Relationship to Child*
Parent/Guardian Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Cell Phone Number
Please enter a valid cell phone number.
Parent/Guardian #2 Place of Employment
Parent/Guardian #2 Relationship to Child
Parent/Guardian Signature*

Clear
Date Signed*

MonthDayYear

Emergency Contact and Physician Information
*Emergency Contact must be someone other than a parent or guardian*
Emergency Contact Name*

First NameLast Name
Emergency Contact Cell Phone Number*
Please enter a valid cell phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact Relationship to Child*
Physician Name*
Physician Number*
Please enter a valid phone number.
Physician Address or Name of Location*
I give my consent for necessary emergency treatment when my child is in the care of their physician and/or hospital/clinic.
Parent/Guardian Initials*

Child Permissions and Authorizations
Summer Sunscreen and Insect Repellant: (All Children)

I acknowledge that during the summer program, Oak Brook School will provide sunscreen. It will be applied each time the children go outside and for water time. We will use clear continuous spray SPF 50 sunscreen. Inspect repellant will be applied per parent request; parent must bring inspect repellant.
Parent/Guardian Initials
Water Activities Permission: (All Children)

I do hereby give permission for my child to participate in the splash pad water activities at Oak Brook School.
Parent/Guardian Initials
Field Trip Permission: (5 years of age and above)

I do hereby give permission for my child to attend all field trips planned. I realize that the Oak Brook staff will do everything in their power to protect my child during these field trips. However, I will not hold them responsible for accidents. I also understand that my child will be transported on the Oak Brook School bus.
Parent/Guardian Initials
General Transportation: (Explorers)

I do hereby give permission for my child to be transported from their elementary school. I understand that the Oak Brook staff will do everything in their power to protect my child during transport. However, I will not hold them responsible for accidents.
Parent/Guardian Initials
Authorization for emergency medical attention:

I authorize Oak Brook School to make the decision to transport my child by way of an emergency ambulatory service. I agree that this service will be at my expense. I agree to not hold Oak Brook School responsible for the actions of said emergency personnel.
Parent/Guardian Initials*
Release of Children:

Oak Brook School will not release a child to any person other than a parent/guardian unless previously notified by the parent. I understand that I must notifty the school in advance if anyone other than the child's parent/guardian is to pick up.
Parent/Guardian Initials*

Medical Information
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Physician Statement of Health:

I have attached or sent a statement of health signed by a health-care professional indicating my child is able to take part in the child-care program.
Physician Statement of Health Upload

Cancelof
Immunization Records:

I have attached or sent a current copy of my child's immunization records and will provide an updated copy to Oak Brook School as my child receives additional immunizations.
Elementary school-age immunizations

My child has their immunization record on file at their elementary school.
Name of Elementary School
Parent/Guardian Signature

Clear
Date Signed

MonthDayYear
Immunization Record Upload

Cancelof
Parent/Guardian Initials
Vision and Hearing Screening: (ages 4 and above)

I have attached or sent a current copy of my child's vision and hearing results. These screenings are typically done during a 4-year-old well check.
Vision and Hearing Screening Results Upload

Cancelof
Parent/Guardian Initials
Nutrition:

According with state minimum standards your child will be served a nutritionally balanced lunch every day. If the posted menu for the day does not work with your child's food allergies or restrictions it will be your responsibility to send in a meal for that day. If you choose to bring lunch for your child, you are taking the responsibility for your child's nutritional needs. A vegetarian option is always available as well.
Parent/Guardian Initials*
Medication:

In an effort to keep kids healthy and free of illness, Tylenol and Ibuprofen will not be administered without a doctor's note due to the fact that they mask symptoms of illness. Medications must be age specific and are only administered at 12:00pm and 4:00pm.
Parent/Guardian Initials*

Authorized Pickup
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Please list any individual who is authorized to pick up your child from Oak Brook School.

Each authorized person must be at least 18 years of age. The above-named child will not be permitted to leave the school with anyone who is not listed below. Authorized individuals must pick up your child in person and may be requested to show identification to school staff. Children will not be released to persons who fail to provide acceptable identification upon request.
Emergency Contact Name

First NameLast Name
Emergency Contact Number
Please enter a valid cell phone number.
Emergency Contact Relationship to Child
Additional Pickup #1

First NameLast Name
Additional Pickup Phone Number
Please enter a valid cell phone number.
Additional Pickup Relationship to Child
Additional Pickup #2

First NameLast Name
Additional Pickup Phone Number
Please enter a valid cell phone number.
Additional Pickup Relationship to Child
Additional Pickup #3
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Additional Pickup #4
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Additional Pickup #5
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Additional Pickup #6
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Additional Pickup #7
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Additional Pickup #8
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Additional Pickup #9
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Additional Pickup #10
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Additional Pickup #11
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Additional Pickup #12
Additional Pickup Phone Number
Please enter a valid phone number.
Additional Pickup Relationship to Child
Signature of Parent or Legal Guardian*

Clear
Date Signed*

MonthDayYear

Photo Release
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
This form is for permission to take and release photos of your child to you. We use a platform called Procare allowing Oak Brook School staff to take pictures of the children throughout the day while at school. We will be sending you the picture(s) digitally. This is a great way to share with you in real time what your child is doing when are not here. Occasionally a photo will be used on Facebook or a slideshow in the school lobby.

Facebook posts are a great way for family and friends to gain insight of what we do here at Oak Brook School Allen--from curriculum, enrichments and mealtime.
Please select an option below:*

I DO give permission for Oak Brook School to take my child's picture for all the above purposes.I DO NOT give permission for Oak Brook School to use my child's picture on social media.
I understand that it is my responsibility to update this form in the event that I no longer wish to authorize the above use. I understand that this form will remain in effect during the term of my child's enrollment at Oak Brook School.
Parent/Guardian Signature*

Clear
Date Signed*

MonthDayYear

Tuition and Enrollment Agreement
The customer agrees to adhere to the above policies and payment schedules.

Signature here indicates you have been reminded of and understand all these OBS reminders and have been given access to the parent handbook on the website and a current rate sheet.
Child's Name

First NameLast Name
Parent/Guardian Signature*

Clear
Date Signed*

MonthDayYear
Should be Empty:

Child Information

Parent/Guardian Information

Emergency Contact and Physician Information

Child Permissions and Authorizations

Medical Information

Authorized Pickup

Photo Release

Tuition and Enrollment Agreement