Enrollment Packet - Perry Rd. Location

I am a...*

Current Parent of Big Dreams & Lil Wonders Christian AcademyNew Parent of Big Dreams & Lil Wonders Christian Academy
I am...*

Completing Annual Registration RenewalUpdating Registration Packet OnlyUpdating CACFP Enrollment Packet Only

Admission Information

Policy & Procedure Acknowledgements
Parent Enrollment Agreement

By initialing verifies that you have read and agree with the policies and procedures listed in the Parent Enrollment Agreement.
I agree to pay a nonrefundable registration fee for my child at the time of enrollment and a re-registration fee every August will be added to the account.

I agree to pay the set weekly tuition for my child, every Monday.

I agree to pay a late fee of $25 if tuition is not paid by Tuesday at noon. On Wednesday your child will not be permitted to attend class.

I agree to pay $1 per minute in late fees if my child is picked up after my designated time, which will be 12 hours for full-time and 6 hours for part-time.

I agree to sign my child in daily on ProCare and NCI. Failure to sign in and out will result in a penalty fee of $10.

I agree to give two weeks' notice prior to the withdrawal of any child from the center. Tuition must be paid and is non-refundable.

I agree to pay 1/2 of my child’s tuition when on vacation after he/she has used their two free weeks.

The Director reserves the right to terminate a child’s admission at any time should the management of the center determine that a child is not adjusting properly.
Initial Here*
Photography and Video Consent

Selecting an option verifies that you have read and agree with the Photography and Video consent form.
I hereby consent that the photographs or videos taken of my child during child care while he/she is enrolled at Big Dreams and Lil WondersChristian Academy as a student, may be used by Big Dreams and Lil Wonders Christian Academy. These pictures may be used forslideshows, emails, bulletin board, brochures, website (www.bigdreamslilwonders.com), Facebook or Instagram page, ProCare, etc.*

I give my permission to use my child's photograph or video, as described aboveI give my permission to use my child's photograph or video within Big Dreams and Lil Wonders Christian Academy ONLYI DO NOT give my consent to have photographs or videos of my child used by Big Dreams and Lil Wonders in any way, as specified above
Discipline and Guidance
I acknowledge the receipt of the Operational Discipline and Guidance Policy*
Role: Parent Caregiver/Employee Household Member*
Gang Free Zone

Under the Texas Penal Code, any area within 1,000 feet of a child care center is a g zone, where criminal offenses related to organized criminal activity are subject to harsher penalties.

Signatures
By signing below, I certify that the information above is true and correct to the best of my knowledge.
Signature*

Clear
Date*

MonthDayYear
Date
Center Designee Signature*

Clear
Date*

MonthDayYear
Date
Infant Admission Information

Operational Policy on Infant Safe Sleep
If an infant needs extra warmth, use sleep clothing blanks* (insert type of sleep clothing such as sleepers or footed pajamas) as an alternative to blankets.
Signatures
Signature*

Clear
Date*

MonthDayYear
Date
Child and Adult Care Food Program

CACFP Letter to Household & Supplemental Information
I acknowledge the receipt of the CACFP Letter to Household, WIC Guidelines & Building the Future Flyer

CACFP Participant Enrollment Form
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Sex*

MaleFemale
Food Allergies?*

YesNo
If yes, please specify*
Race of Participant (Optional)

WhiteBlack/African AmericanAmerican Indian/Alaska NativeAsianNative Hawaiian or Other Pacific Islander
Ethnic Identity (Optional)

Hispanic or LatinoNot Hispanic or Latino
Check Days of Normal Care at facility:
Monday   Tuesday   Wednesday   Thursday   Friday*
Check meals normally eaten at facility:
Breakfast   AM Snack   Lunch   PM Snack   Supper   Evening Snack*
Please list the normal times of arrival and departure :
Arrive:   Time*
Departure:   Time*
This institution/facility offers Parent's Choice (Walmart & Sam's Brand) formula for infants through CACFP. It is your choice whether or not to use this formula based on your infant's needs. Baby foods provided by the institution/facility must be in compliance with the infant meal pattern as required by 7CFR 226.20.

	Today's Date 6 - 11 months
I want the provider to provide the infant cereal and other foods for my infant
I will bring the infant cereal and/or other foods for my infant
My child is NOT developmentally ready for solid foods. I will inform the provider when and designate the solid food(s) to be introduced to my infant at that time

Signatures
Signature*

Clear
Name*

First NameLast Name
Date*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Emergency Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Last 4 of SSN*
I do not have a Social Security Number

Should be Empty:

	Today's Date 0 - 5 months	Today's Date 6 - 11 months
I will bring expressed milk for my infant
I want the provider to provide the infant formula for my infant
I will bring the infant formula for my infant

Admission Information

Emergency Contact

Authorized Pickup

School Age Children

Child Special Care Needs & Allergies

Authorization for Emergency Medical Attention

Hearing & Vision Exam

Vision Exam Results

Hearing Exam Results

Admission Requirement: Physician Health Statement

Vaccination Record

Varicella (Chickenpox)

Parent Enrollment Agreement

Photography and Video Consent

Discipline and Guidance

Gang Free Zone

By signing below, I certify that the information above is true and correct to the best of my knowledge.

Infant Admission Information

Big Dreams & Lil Wonders Christian Academy will feed your infant breast milk provided by you and/or we will provide Infant formula. The formula we provide is Parent’s Choice (Walmart or Sam’s Brand).

Signatures

Child and Adult Care Food Program

Name of All Household Members

Benefits

Total Household Gross Income - You must tell us how much and how often

Sharing Information With Other Programs