Enrollment Packet - Perry Rd. Location
  • I am a...*
  • I am...*

  • Admission Information

    • General Information 
    • First Day of Enrollment*
       - -
    • Date of Birth*
       - -
    • Who does the child live with?*
    • Does your child attend school?*
    • Is your child an infant (0-11 months)?*
    • Is the Parent or Guardian's address different from the child's?*
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.
    • Custody Documents on file?*

    • Emergency Contact

    • Format: (000) 000-0000.

    • Authorized Pickup

      I authorize the child care operation to release my child to leave the child care operation ONLY with the following persons.
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.

    • School Age Children

    • Format: (000) 000-0000.
    • My child has permission to (check all that apply):*
    • The child's required immunizations, vision and hearing screening, and TB screening are current and on file at their school.*
    • Consent Information 
    • Transportation: I give consent for my child to be transported and supervised by the operation's employees (Check all that apply):*
    • Field Trips:*
    • Water Activities: I give consent for my child to participate in the following water activities (Check all that apply):*
    • Is your child able to swim without assistance?*
    • Meals: I understand that the following meals will be served to my child while in care (Check all that apply):*

    • Days and Time in Care: My child is normally in care on the following days and time

    • Until
    • Until
    • Until
    • Until
    • Until
    • Medical Information 

    • Child Special Care Needs & Allergies

    • Child day care operations are public accommodations under the Americans with Disabilities Act (ADA), Title III. To learn more, visit https://www.ada.gov/resources/child-care-centers/. If you believe that such an operation may be practicing discrimination may call the ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY).

    • Does your child have diagnosed food allergies?*
    • Does your child have any special care needs (food intolerances, existing illness, etc.)?*
    • Check all that apply:*

    • Authorization for Emergency Medical Attention

      In the event I cannot be reached to arrange for emergency medical care, I authorize the person in charge to take my child to:
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.

    • Hearing & Vision Exam

    • Select the option that applies to your child*

    • Vision Exam Results

    • Right Eye 20/ * Left Eye 20/ *
         *   

      Signature:   *   Date:   Pick a Date*   
            

    • Hearing Exam Results

    • Right Ear
      1000 Hz   *   2000 Hz   *   
      4000 Hz   * 
         *      

    • Left Ear
      1000 Hz   *   2000 Hz   *   
      4000 Hz   * 
         * 

      Signature:   *   Date:   Pick a Date*               

    • Admission Requirement: Physician Health Statement

    • If your child does not attend pre-kindergarten or school away from the childcare operation, one of the following must be presented when your child is admitted to the childcare operation or within one week of admission (Select only one option)*

    • Vaccination Record

    • Select the option that applies to your child.*
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    • Varicella (Chickenpox)

    • The Varicella (chickenpox) vaccine is not required if your child has had chickenpox disease. If your child has had chickenpox, please complete the statement:

      My child had varicella disease (chickenpox) on or about   Pick a Date*  
      Signature:   *   Date:   Pick a Date*   
             

    • 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.

    • 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.*

    • Discipline and Guidance

    • *      
      Role:         *   

    • 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. 

    • Date*
       - -
    • Date*
       - -

    • Infant Admission Information

    • Infant Care Sheet 

    • 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).

    • Can your infant have a warmed bottle?*
    • Does your child have allergies?*
    • Do we have permission to use the following items? Select all that apply.*
    • Does your infant use a pacifier?*
    • Operational Policy on Infant Safe Sleep 

    • If an infant needs extra warmth, use sleep clothing * (insert type of sleep clothing such as sleepers or footed pajamas) as an alternative to blankets.

    • Signatures

    • Date*
       - -

    • Child and Adult Care Food Program

    • CACFP Letter to Household & Supplemental Information 
    • CACFP Participant Enrollment Form 
    • Date of Birth*
       - -
    • Sex*
    • Food Allergies?*
    • Race of Participant (Optional)
    • Ethnic Identity (Optional)

    • Check Days of Normal Care at facility:
                  * 
      Check meals normally eaten at facility:
                     *    
      Please list the normal times of arrival and departure :
      Arrive:   *            
      Departure:   *   
          

    • 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.

    • Rows
    • Rows
    • CACFP Income Eligibility Form 

    • Name of All Household Members

    • *
    • *
    • *
    • *
    • *
    • *
    • *
    • *
    • *
    • *
    • *
    • *
    • *
    • *

    • Benefits

    • Does anyone in your household receive SNAP, TANF, or FDPIR?*

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

      Note: Self-Employed report income after expenses in (1) | If you receive no income for any one of the following fields, please enter 0.

    • Name:   *   *   
      1. Earnings from work before deductions  $    *   *   
      2. Welfare, child support, alimony $   *   *   
      3. Pensions, retirement, Social Security, SSI, VA benefits
      $   *   *   
      4. All Other Income $   *   *   

    • Name:   *   *   
      1. Earnings from work before deductions  $    *   *   
      2. Welfare, child support, alimony $   *   *   
      3. Pensions, retirement, Social Security, SSI, VA benefits
      $   *     *    
      4. All Other Income $   *   *   

    • Name:   *   *   
      1. Earnings from work before deductions  $    *   *   
      2. Welfare, child support, alimony $   *   *   
      3. Pensions, retirement, Social Security, SSI, VA benefits
      $   *   *   
      4. All Other Income $   *   *   

    • Name:   *   *   
      1. Earnings from work before deductions  $    *   *   
      2. Welfare, child support, alimony $   *   *   
      3. Pensions, retirement, Social Security, SSI, VA benefits
      $   *   *   
      4. All Other Income $   *   *   

    • Name:   *   *   
      1. Earnings from work before deductions  $    *   *   
      2. Welfare, child support, alimony $   *   *   
      3. Pensions, retirement, Social Security, SSI, VA benefits
      $   *   *   
      4. All Other Income $   *   *   

    • Sharing Information With Other Programs

    • The above information may be disclosed for the purpose of enrolling children in the Children's Health Insurance Program(CHIP). Parents/guardians are not required to consent to such disclosure and electing not to allow disclosure will not adversely affect a child's eligibility. (Optional)
    • Signatures 
    • Date*
       - -
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.
    • Format: (000) 000-0000.
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