Registration Packet

Admission Information
First Day of Enrollment*

MonthDayYear
Date
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Who does the child live with?*

Both ParentsMomDadGuardian
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Does your child attend school?*

YesNo
Is your child an infant (0-11 months)?*

YesNo
Name of Parent or Guardian*

First NameLast Name
Is the Parent or Guardian's address different from the child's?*

YesNo
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent or Guardian's Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent or Guardian's Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Custody Documents on file?*

YesNo
Emergency Contact
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Authorized Pickup

I authorize the child care operation to release my child to leave the child care operation ONLY with the following persons.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
School Age Children
School Name*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
My child has permission to (check all that apply):*

Walk to or from school or homeRide a busBe released to the care of his or her sibling under 18 years old
Authorized pick up or drop off location other than the child's address:*

Location Name

Street Address

CityState / Province

Postal / Zip Code
The child's required immunizations, vision and hearing screening, and TB screening are current and on file at their school.*

YesNo
Consent Information
Transportation: I give consent for my child to be transported and supervised by the operation's employees (Check all that apply):*

For Emergency CareOn Field TripsTo and From HomeTo and From School
Field Trips:*

I give consent for my child to participate in field tripsI do not give my consent for my child to participate in field trips
Water Activities: I give consent for my child to participate in the following water activities (Check all that apply):*

Water Table PlaySprinkler PlaySplashing or Wading PoolsSwimming PoolsAquatic Playgrounds
Is your child able to swim without assistance?*

YesNo
If no, what type of assistance is needed?*
Please review the Parent Policy and Procedures Handbook.
Receipt of Written Operational Policies:*

I acknowledge receipt of the facility's operational policies.
Meals: I understand that the following meals will be served to my child while in care (Check all that apply):*

NoneBreakfastMorning SnackLunchAfternoon SnackSupperEvening Snack
Days and Time in Care: My child is normally in care on the following days and time
My Child will not be attending on Monday
Monday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
My Child will not be attending on Tuesday
Tuesday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
My Child will not be attending on Wednesday
Wednesday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
My Child will not be attending on Thursday
Thursday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
My Child will not be attending on Friday
Friday*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
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?*

YesNo
Does your child have any special care needs (food intolerances, existing illness, etc.)?*

YesNo
Check all that apply:*

None of theseEnvironmental allergiesFood intolerancesExisting illnessPrevious serious illnessInjuries and hospitalizationsLimitations or restrictions on child's activitiesReasonable accommodations or modificationsAdaptive equipment (include instructions below)Symptoms or indications of complicationsMedications prescribed for continuous long-term useOther
Explain any needs selected above:*
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:
Name of Physician*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name of Emergency Care Facility*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
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
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.
By signing below, I certify that the information above is true and correct to the best of my knowledge.
Signature*
Date*

MonthDayYear
Date
Infant Admission Information
R & R Learning Center 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).
What type of milk will you bring for your infant?*
Formula Brand*
Can your infant have a warmed bottle?*

YesNo
If child is receiving breast milk and supply of pumped milk runs out, what do you want staff to do?*
List of baby food your infant consumes (i.e. cereal, fruits, vegetables)*
How often and how much does your child eat during a feeding?*
Does your child have allergies?*

YesNo
If yes, explain:*
Do we have permission to use the following items? Select all that apply.*

LotionBaby WashBaby PowderDiaper Rash OintmentNone of these
If you are brand specific: List the brand name & provide the products, if they differ from the brand used at the center.*
If you are not brand-specific, please put N/A as an answer
Does your infant use a pacifier?*

YesNo
If yes, any special instructions regarding its use?*
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*
Date*

MonthDayYear
Date
Should be Empty:

Admission Information

Emergency Contact

Authorized Pickup

School Age Children

Consent Information

Child Special Care Needs & Allergies

Authorization for Emergency Medical Attention

Parent Enrollment Agreement

Photography and Video Consent

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

R & R Learning Center 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