Michelle International Application

Michelle's International Learning House Enrollment Application

Student Information
Participant’s Name:*

First NameLast Name
Emergency Code:*
Gender:*
Date of Birth:*

MonthDayYear
Date
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Insurance Company:*
Policy#:*
Allergies:*
MILH hours of operation are Monday- Friday from 7:30 AM - 5:30PM

Parent Information

Parent#1
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Employer:*
Work#:*
Please enter a valid phone number.
Parent 2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number:
Please enter a valid phone number.
Cell Phone Number:
Please enter a valid phone number.
Email
example@example.com
Employer:
Work Phone Number
Please enter a valid phone number.
Does your child have an IEP?*

YesNo
If yes, would you be willing to share the IEP with us?*
Email
example@example.com
Other than parent(s) listed above, who may pick-up or be notified in case of illness, accident, or emergency?
Parent #1 permitted?*

YesNo
Parent #2 permitted?*

YesNo

Additional Emergency Pick-Up/Notification:
Name:*
Phone Number*
Please enter a valid phone number.
Relationship:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to add additional contact information?*

YesNo
Name:
Phone Number:
Please enter a valid phone number.
Relationship:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name:
Phone Number
Please enter a valid phone number.
Relationship:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physician’s Name:
Physician’s #:
Please enter a valid phone number.
In the event I cannot be reached in an emergency, I give consent to Michelle’s International Learning House to select a physician, and for said physician to hospitalize, secure proper treatment for, and to order, inject and/or anesthesia and/or surgery for my child, as named above. I understand that Michelle’s International Learning House has secondary insurance coverage and that the personal insurance bears primary responsibility in case of accident. The undersigned expressly recognizes that there are risks in children’s play and I hereby grant permission for my child to use all of the playground equipment and to participate in all activities of the school.
Parent/GuardianSignature:*

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Date

Photography Consent Form
Dear Parent/Guardian,

As the parent of a child(ren) at Michelle’s International Learning House, I agree to the following:

I understand that my child(ren) whose name(s) are listed below may be photographed at Michelle’s International Learning House during normal childcare hours, field trips, or activities. I understand that these photographs may be used in promoting child care services, either in print or on the internet.
Parent/Guardian Name:

First NameLast Name
Relationship to child:
Child 1 Name:
Child 2 Name:
Child 3 Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I give permission for my child(ren) to be photographed, or their images recorded for print or electronic use in promoting our child care services. I understand that it is my responsibility to update this form in the event that I

no longer wish to authorize the above uses. I agree that this form will remain in effect during the term of my child’s enrollment. I understand that there will be no payment for me for my child’s participation.
Parent/Guardian Signature:

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Name:
Date:

MonthDayYear
Date

Nutrition Form
Dear Parent:

In accordance with Broward County Child Care Ordinance, parents and the child care facility are urged to work cooperatively to assure that children are provided with nutritious snacks and meals where lunches are not provided by the facility.

Please read the following carefully, amd sign.
The parent agrees to provide a nutritious:

Mid-morning snackLunchMid-afternoon snack
I have read the preceding and agree to meet the child’s nutritional needs as defined above.
Parent’s Signature*

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MonthDayYear
Date

Parent/Guardian Release of Information
Michelle’s International Learning House is held accountable by county, state and our accreditation agency. These entities do periodic inspections and may randomly choose children’s files for compliance checks. In addition, in the case of an emergency, Michelle’s House staff may need to access your child’s file in order to reach you. Please sign below granting permission to share your child’s information with these parties under these, or other necessary circumstances.
Child’s Name:*
Parent/Guardian's Name:*
Parent/GuardianSignature:*

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Date*

MonthDayYear
Date

Authorization For Emergency Treatment
Today’s Date*

MonthDayYear
Date
To Whom it may concern:
I hereby give consent to Hospital name* to administer necessary treatment of my child,name of child* in the event of an emergency at which time I cannot be reached. I give consent to transport by ambulance if situation warrants it.
Name of Physician*
Phone*
Allergies of Child:*
Date of Last DPT or Tetanus*

MonthDayYear
Date
Insurance Company Covering Child*
Policy Number*
Signature of parent or legal guardian:*

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Expiration Date*

MonthDayYear
Date
Today's Date:*

MonthDayYear
Date

Discipline Policy
Parent/Guardian Signature:*

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MonthDayYear
Date

Parent/Guardian signature:*

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Date

PHYSICAL ACTIVITY
I grant permission for my child to participate in physical activity at Michelle’s International Learning House. I am aware that my child will participate in at least forty (40) minutes of physical activity for every three hours in child care. I confirm that my child has no limitations that would prevent him/her from participating. In the event that weather does not allow for outdoor play my child’s teacher will utilize the inclement weather activities to ensure that the children participate in physical activity indoors.

Proper attire must be worn by children at all times. Rubber -soled, closed shoes must be worn. Clothing should not have long drawstrings or other tripping hazards, including overly long pants or skirts. Clothing should be comfortable and weather appropriate.

Children are scheduled for playground time both in the morning and the afternoon.
Child’s Name:*
Parent's Name:*
Signature*

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Date

SECTION A (Credit Card)
We are excited to offer the safety, convenience and ease of Tuition Express®—a payment processing system that allows secure, on-time tuition and fee payments to be made from either your bank account or credit card.

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT and CREDIT CARD
I (we) hereby authorize Michelle's International Learning House to initiate credit card charges to the below-referenced credit card account (Section A) OR, initiate debit entries to my (our) checking or savings account, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. Credit union members: please contact your credit union to verify account and routing numbers for automatic payments.
Check with the center for accepted credit card types.
Please select which section you will be providing.*

SECTION A (Credit card)SECTION B (Bank Account)
Cardholder Name:
Phone Number:
Please enter a valid phone number.
Cardholder Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Card number
Expiration date
Cardholder Signature:

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Today's Date:

MonthDayYear
Date
Your name:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank or Credit Union Name:
Banks or Credit Union Address:
Routing Transit Number:
Account number:
Please select one:

CheckingSavings
Authorized Signature:

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Today's Date:

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Date

Voluntary Pre-Kindergarten Attendance Policy
Will your child be enrolled into the VPK program?*

YesNo

VOLUNTARY PRE-KINDERGARTEN ATTENDANCE POLICY
To the parent of:
Your child is enrolled in the state-funded, Voluntary Pre-Kindergarten (VPK) program. Students enrolled in additional programs were given that information at the time of enrollment. This is a state-funded program, there are rules and regulations that both the provider and the parents must follow. The state of Florida has designed the attendance rules for the VPK program. You will be asked to sign a confirmation that you received this and initial each key point. PLEASE READ THE INFORMATION BELOW CAREFULLY! This agreement contains the following information:

1. SIGN IN/ATTENDANCE VERIFICATION

2. ATTENDANCE & ABSENCE POLICY

3. TRANSFER/TERMINATION PROCESSES

4. DROP OFF/LATE PICK UP FEES

5. WITHDRAWAL FROM WRAP-AROUND SERVICES

1. Sign In/Attendance Verification

Your child must be dropped off inside of the classroom or playground and must never be dropped off in a classroom without a teacher in the room. You must utilize the fingerprint system daily as your child’s attendance verification. Therefore, your child will be signed in upon arrival and signed out at dismissal every day by the adult who drops off and/or picks up. Each child will have their own monthly attendance sheet (“Student Attendance and Parental Choice Certificate”) located in the binder on the front office desk. This sheet must be signed on the last day of each month throughout the school year.
Parent Initial:
2. Attendance/Absence

Regular attendance is required in this program. It is important that your child attends every day in order to receive the maximum benefits of this academic program.

Please note: It is a state requirement that parents comply with the center’s attendance policy as well as any of its other policies and procedures. The state VPK program allows a center/school to dismiss a child who does not follow these rules. Additionally, there are rules and regulations that might restrict your ability to transfer to another provider should your child be dismissed either for non-attendance or non-compliance to center rules.

DAILY ABSENCES The program at Michelle’s International Learning House will run for 540 hours during the school year and follow the Broward County School’s Schedule. During the summer the program will run for 300 hours. Parents are given that schedule at the time of registration along with information pertain to fees for Non-VPK days that a parent may elect to utilize.

STUDENTS ARE ENCOURAGED TO ATTEND EACH DAY SCHOOL IS SCHEDULED AND FOR PARENTS TO SCHEDULE DOCTORS APPOINTMENTS AND VACATIONS DURING NON-VPK HOURS/DAYS.

Voluntary Pre-Kindergarten (VPK) is a state supported program. Payment for attendance is based upon the “Voluntary Pre-Kindergarten (VPK) 80:20 Rule.” Schools are reimbursed based on student attendance and are only reimbursed for days students are in school. Students who have absences over 20 percent cost the school additional money, as the school is not paid for the additional absences. Therefore, Michelle’s International Learning House reserves the right to withdraw any child who is absent above 20 percent of the scheduled VPK classroom time.
Parent Initial:
3. Transfer/Termination

A. Should you decide at any time after the start of the VPK program that you wish to transfer your child to another provider it is the parent’s responsibility to notify Michelle’s International Learning House. VPK certificates are allowed to be transferred only once in a school year.

B. At Michelle’s International Learning House we strive to meet the need of all the children and families in our school. Please feel free to consult with us on any issues. Through our vast experience in the field of education and our community contacts, we are able to match children with the appropriate education as well as any necessary outside resources and referrals. There are occasions when despite our best efforts we are unable to accommodate a particular child or family. Whether the situation is that the

C. placement is not appropriate for that child or there is non-compliance with the policies and procedures outlined in this agreement or the Michelle’s International Learning House Parent Handbook, we reserve the right to terminate services.

4. Drop off & Late Pick-up

Children enrolled in the three-hour VPK class may arrive no sooner than 5 minutes before the start of class. A child who is enrolled in the VPK program but is not enrolled for any other wrap-around services must be picked up by the end of the scheduled program. All three-hour VPK children will be brought to the front office for pick up at the end of the program day. Parents are responsible to pick up their child in a timely manner. Please review the Michelle’s International Learning House Parent Handbook for late pick up procedures and fees. There is a charge of $10.00 per hour after Noon or any part of the hour.
Parent Initial:
5. Withdrawal from Wrap-Around Services

If at any time a parent withdraws their child from the Wrap-Around services offered by Michelle’s International Learning House but chooses to remain in the VPK program at Michelle’s International Learning House, may do so (one change per calendar year) but Michelle’s International Learning House reserves the right to move that child into a different Pre-Kindergarten class at Michelle’s International Learning House depending on space available.
Parent Initial:
Thank you for taking the time to review these policies. The Florida Office of Early Learning may modify their policies. You will be notified of any changes in writing. As part of our registration packet you received our Parent Handbook that will give you additional information regarding Michelle’s International Learning House operational policies. Please refer to this handbook for additional information of any practice that is not directly affected by the VPK program. We look forward to a successful school year. Thank you for choosing Michelle’s International Learning House as your VPK provider. I have received a copy of the Voluntary Pre-Kindergarten Attendance Policy and will adhere to all policies.
Parent’s Signature:

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Date
Parent’s Name:
Child’s Name:
Will Child be attending the three-hour VPK program with extended Wrap-Around Program?

YesNo
Will Child be attending the three-hour VPK program without the Wrap-Around Program?

YesNo

Child's Name:*
Parent Name:*
Signature:*

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Michelle’s International Learning House CoronaVirus Pandemic Strategic Plan
Current Recommendations: Childcare centers are being encouraged to remain open to serve those who do not have the ability to work from home.

Phase I – phase I is if the outbreak is in nearby communities but not in our own)

• Follow CDC and health department recommendations.

• Update families on our current status regularly and post any signs provided by the health department

• During this phase, if someone NOT interacting with the learning center tests positive, we will evaluate risk to our school. If deemed necessary, we will close for up to 48 hours so that deep cleaning protocols can be enacted.

• If someone within our school tests positive, or has exposure to someone who has tested positive, we will close for 48 hours or longer, depending on CDC recommendations and have healthy staff come in to fully clean based on cleaning procedures recommended by the CDC/health department.

• Cleaning and handwashing procedures will be as follows:

• Families will be reminded at pick up and drop to wash their own child’s hands for a minimum of 20 seconds.

• During phase 1, we will add additional cleaning for high touch areas at 10am and 4pm. Teachers will be retrained on proper handwashing techniques and ways to help children thoroughly wash their hands.

• Any toys that might be mouthed will be collected and washed immediately and at least daily. All toys will be cleaned and thoroughly sprayed with bleach at the end of each day. All counters, shelves, surfaces will be wiped down with our bleach solution at the end of each day.

• We are increasing the level of our exclusion practice with children and staff. We are asking families to keep children home that show any signs of illness, temperatures of 100 or above will require exclusion until fever free for 24 hours without medication and will require a doctor’s note.

• If we are low on staff, we will operate at licensing ratios and if necessary, only accept children up to staff limitations imposed by said ratios, on a first come, first serve basis. Children may be combined with other classrooms to allow the maximum number of families to receive care daily.

Phase II (outbreak is within our community, government is enacting social distancing rules and beginning to shut down high risk areas such as schools, events, etc.)

• Continue protocols of Phase I unless following extended protocols below

• Remain open until mandated to close, as long as no positive results are among staff and families. If a positive result presents itself, we will go to Phase III

• Update families with the latest information we receive • Bedding will be sent home daily for laundering rather than weekly.

• Increase illness exclusion restrictions. Temperatures of 99.5 or higher will be excluded as will other symptoms such as cough or severe fatigue. Children and staff with these symptoms will be excluded for 72 hours. If symptom free after 72 hours WITHOUT the aid of medication child/staff may return with doctor clearance. If symptoms persist exclusion will be required until a negative coronavirus test result is determined.

• Staff and families will be updated as quickly as possible.

• Enhanced cleaning procedures will include hourly wipe downs of high touch areas, fully disinfecting shelves and toys at closing, remove any high risk/hard to clean toys. Infant and toddler teachers will place toys played with, even if not mouthed in buckets to be washed and disinfected daily, as well as, as needed.

• Preschool children will assist in washing toys. Toys and materials will be removed if coughed or sneezed on and at the end of each day, or after high touch use.

• All sensory activities involving shared materials will be suspended.

• Families are responsible for making sure their contacts are up to date. If a child becomes symptomatic and we cannot reach family or alternative contacts given, authorities will be called.

• Staff choosing not to come in will not be paid.

• Children will not be permitted to bring items, such as toys, from home.

• School age children enrolled in our after- school program and now attending full day, will be charged the full fee.

• Social distancing among young children is almost impossible. Children cannot understand this concept. What’s more, during these tense uncertain times children need comfort more than ever. We will be encouraging small group play and extended outdoor time.

• Require high risk staff to stay home.

• All staff will practice social distancing outside of the classroom and best that they can within the classroom.

• Staff will wash their hands and the hands of the children together every time to make sure it is done properly.

Phase III (This phase will be enacted if we have a positive test among staff or families. Since we have siblings, we will close the entire school or we will enter this phase if mandated to close.)

• Day 1 of closure no child care will be provided so that our school can be prepared for possible extended closure.

• Resources and information will be shared with families

• In the event that we are mandated quarantined as a community, front line responders and health care workers who do not have back up care will be our first priority in aiding them to find back up care for their children.

• During mandatory quarantine, we will update families and staff daily through our Remind app and Facebook, and suggest activities for children. We will implement a daily story time video, if possible, as well.

Phase IV (phase IV will have two parts: Part A if a partial quarantine is lifted, but centers are not reopened. Part B is if full quarantine is lifted and we are able to open, but there is still a potential for new cases.

Part A

• As soon as we are able to and partial quarantine is lifted, we will return to Phase III. Health care workers and first responders will again be given priority, and then other families that have been tested and have negative results.

• Prepare center to reopen

• Reach out to families to determine status

• Reach out to staff to determine status • Follow steps in Phase III

Part B

• When quarantine is lifted and we are allowed to reopen, we will notify parents of reopening date. Staff will be scheduled to come in to prepare for opening.

• Families will be asked to stagger arrival on the first day, so that we may help each child to readjust individually. During extended breaks in care, some children can return easily while others need much comforting. We want to make sure their return is as smooth as possible.

• We will return to Phase II on the first week of care and Phase I when we feel comfortable, with the goal being week two.

• Once the crisis is completely resolved, we will review all of our cleaning and health policies to make sure we are continuing pertinent but common sense practices.

Parent Initial:*

Know your Child Care Facility
I parent name* have receive and read the "Know your child center" brochure.
Child's Name:*
Parent signature:*

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Influenza
Durind the 2009 legislative session a new law was passed the requires child care facilities, family day care homesand large family homes provide parents with infromation detailing the cause, symptons, and transmission of the infuenza virus (the flu) every year during August and september.
Parent Name:*
Child Name:*
Today's Date:*

MonthDayYear
Date
Signature:*

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Facts About Heatstroke
Parent/Guardian:*
Child name:*
Date*

MonthDayYear
Date

Safe Sleep for your baby
Parent Initial:*
Should be Empty:

Michelle's International Learning House Enrollment Application

MILH hours of operation are Monday- Friday from 7:30 AM - 5:30PM

Parent Information

Additional Emergency Pick-Up/Notification:

Photography Consent Form

Nutrition Form

Parent/Guardian Release of Information

Authorization For Emergency Treatment

Discipline Policy

PHYSICAL ACTIVITY

SECTION A (Credit Card)

Voluntary Pre-Kindergarten Attendance Policy

VOLUNTARY PRE-KINDERGARTEN ATTENDANCE POLICY

Michelle’s International Learning House CoronaVirus Pandemic Strategic Plan

Know your Child Care Facility

SWIM Central Water Safety Education Questionnaire

Influenza

Facts About Heatstroke

Safe Sleep for your baby