Annual Renewal Registration Form

Annual Renewal Registration Form
Full Name of Child*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
ALLERGIES OR SENSITIVITIES

Does your child have any known allergies or sensitivities to: (If it doesn't apply to your child type N/A)
Medications:*
Foods:*
Other:*
ILLNESSES OR MEDICAL CONDITIONS: CHECK ALL THAT APPLY Does your child have any of the following conditions
List any addition health information or special instructions you feel we need to be aware of:*
List any Regular Medications your Child Takes:*
Name of Child's Medical Provider:*
MEDICATION RELEASE FORM

Every field must be filled up. If not applicable write N/A.
Name of Child:*
Age:*
Name of Medication:*
Condition Being Treated:*
Date(s) Medication is to be Given:*
Time(s) Medication is to be Given:*
Dosage / Amount to be Given:*
Method of Administration (For Example, Orally, Topically, Nasally, Etc):*
Possible Side Effects or Interactions with Other Drugs:*
Signature of Parent or Guardian*

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Read - Checkbox - Sign

I hereby give my permission for the provider to administer this medication according to the instructions above. I agree that the provider will not be held liable for any illness or injury resulting from the administration of this medication, and will not be held responsible for the reimbursement of any medical expenses resulting from such action.
Signature of Parent Or Guardian:*

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Date:*

MonthDayYear
Today's Date
VERBAL MEDICATION AUTHORIZATION RELEASE FORM

This form is used only when a child may need medicine. These are the following procedures: 1- Parent / Guardian will be contacted by phone 2- Parent / Guardian will have to give consent over the phone to give the medicine and desire dosage. 3- Staff member will have to record the date, time and dosage that the parent requested. You can see all of this information in the app after being recorded.
Signature of Parent or Guardian:*

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Date:*

MonthDayYear
Today's Date
A COPY OF THE FOLLOWING SECTION WILL BE CARRIED WITH A KIDSBORO ACADEMY INC. STAFF MEMBER WHEN TRANSPORTING YOUR CHILD OR IN THE EVENT OF AN EMERGENCY.
Medical Release

The undersigned gives permission for Kidsboro Academy Inc. owners, employees, and/or agents to seek emergency medical treatment for the participant(s) in the event they are unable to reach any parent or guardian. The undersigned also agrees that they themselves will be responsible for any financial debt incurred by said action.
Signature of Parent or Guardian:*

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Date:*

MonthDayYear
Today's Date
A COPY OF THE FOLLOWING SECTION WILL BE CARRIED WITH A KIDSBORO ACADEMY INC. STAFF MEMBER WHEN TRANSPORTING YOUR CHILD OR IN THE EVENT OF AN EMERGENCY.
Transportation Release

I give permission for my child to be transported either by Kidsboro Academy Inc. transportation or by other commercial or public transportation for field trips or to school.
Child First NameChild Last Name
Gender*

MaleFemale
Parent Name:*

Parent/Guardian First NameParent/Guardian Last Name
Phone Number:*
Please enter a valid phone number.
Second Phone Number:
Enter if you have one
Signature of Parent or Guardian*

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Date:*

MonthDayYear
Today's Date
Upload Immunization Records:*

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Upload a Picture of your Child:*

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Parent 1 Info*

Parent 1: First NameParent 1: Last Name
Parent 1: Email*
example@example.com
Parent 1: Phone Number*
Enter a valid phone number.
Parent 2 Info*

Parent 2: First NameParent 2: Last Name
Parent 2: Email*
example@example.com
Parent 2: Phone Number*
Enter a valid phone number.
Child / Children's Address*
City*
State*
County*
Zip Code*

Authorized Pickup Info *
Requirement

We are required to have at least one outside state emergency contact besides parents or guardians (If you have one).

Policy & Waiver
LIABILITY WAIVER

The undersigned being the lawful parent and/or guardian of the above child/children hereby consent to the participation by the child/children in all activities conducted by Kidsboro Academy Inc. and to the participation of the above child/children in all events related to said activities.

The children participate in the classes, activities, summer camps, sports like Dance, Martial Art Brazilian Jiu-Jitsu, Finest and Tumbling, field trips, swimming at summer camp, and adventures with Kidsboro Academy Inc. are consistently well supervised; however, accidents do happen. The undersigned assumes all risk of injury or harm to the child/children associated with participation in Kidsboro Academy Inc. classes, activities, summer camps, sports like Dance, Martial Art Brazilian Jiu-Jitsu, Finest and Tumbling, field trips, swimming at summer camp, and adventures and agrees to release, indemnify, defend, and forever discharge Kidsboro Academy Inc. and its subsidiaries, vendors, staff, employees, and agents of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action in respect of death, injury, loss or damage to the child/children, howsoever caused, arising by reason of or during the child/children participation in Kidsboro Academy Inc.
ASSUMPTION OF RISK

Participation in physical activities can involve motion, rotation, and physical conditioning. The undersigned and the participant(s) voluntarily assume all risks of loss, damage, or injury that may be sustained by the participant(s) and/or the undersigned or any property owner by them while on or upon said premises above. The limited liability company may but shall not be obliged to carry insurance on the participant(s). The existence of insurance shall not change, alter, or increase the LLC's liability to the participant(s) and the undersigned or affect the terms of this Release. In signing the Release, the undersigned acknowledges:

a) That they have read thoroughly and understands the terms of the Registration and Release completely and signs it voluntarily.

b) That the undersigned signing either for themselves or as Legal Guardian is, in fact, the true and legal guardian and has the consent of the participant(s).
PERMISSION FORM

1. I hereby permit Kidsboro Academy Inc. to teach the above child/children: language, math, music, art, craft, and motor skill. I permit to enroll my child in Preschool with his or her age group and to learn from the curriculum of Kidsboro Academy Inc.

I understand the above child/children are set up by groupage and organized accordingly to the Utah Department of Health Child Care Licensing.

2. I hereby permit Kidsboro Academy Inc to teach the above child/children Dance, Martial Art Brazilian Jiu-Jitsu, Finest, and Tumbling.

3. On occasion, Kidsboro Academy Inc. may receive requests from other professionals or by the community to observe the program. We attempt to do this with the least disturbance to the children’s routine. I hereby permit my child to be present on these occasions.

4. I hereby permit pictures and/or videos to be taken of the above child/children in the program setting for general record-keeping purposes and shared with parents.

5. I hereby permit sunscreen to be applied to the above child/children before outdoor activities.

6. I hereby permit the above child/children to be transported in the event of an emergency & natural disaster.

7. I hereby give the above child/children permission to go on field trips arranged by Kidsboro Academy Inc. staff. I understand that I will be informed in advance of any special field trips.

8. I hereby give the above child/children permission to go on the van to be transported to and from school by Kidsboro Academy Inc. staff. I understand that Kidsboro Academy Inc. will inform me of any delays at drop-off or pick-up time that may happen. I understand that Kidsboro Academy Inc. can be late up to 30 minutes in case of any emergency and may request me to call the school and hold my child in the office until the driver shows up.

9. I hereby permit the above child/children to go on summer camp with Kidsboro Academy Inc. staff. I understand the summer camp change by year, and the academy will give the new schedule in the summertime. Good behavior is suspected at all times; if rules are not followed, the child/children might be temporarily removed from the program and stay at the facility to do other activities. If inappropriate behavior persists, the child/ children will be removed from the program for the summer season and stay at the facility to do other activities.

10. Child Discipline: Positive reinforcement and clear expectations are what is practiced at Kidsboro Academy. I believe in praising children who try to follow the rules. However, in cases when the child is hurting himself/herself, others, private property, or behaving inappropriately, the child will be asked to sit and relax, when the child is ready to speak, will ask to speak with us and explain what happened so we can teach the child to understand his or her feeling, circumstances, situations, and many other things. Kidsboro Academy strongly believes that kids don’t do things with the same intention as adults do. That is why we like to take a different approach under these circumstances to teaching how to behave and act under those circumstances.

We can explain to you more about how we approach a disciplinary situation.

11. Nap Time/ Quiet Time

All children will be allowed to nap/or have quiet time.
CANCELLATION & REFUNDS

We understand plans change. We will gladly issue a full refund for any cancellation requests received more than 30 days before starting the program. No refunds on cancellation notices received less than 30 days before the first day of the program.

Kidsboro Academy reserve the right to terminate this contract for any reason. The parent will get two weeks’ notice under usual circumstances. However, I reserve the right to immediate termination of services under certain circumstances. (i.e., Children - Parents or Guardians who are a threat to others, etc.)
INFECTION CONTROL/ILLNESSES

Sick children may not attend Kidsboro Academy

THIS IS A STATE REGULATION.

Sick children make the other children sick too. If a child has any of these symptoms before coming to Kidsboro Academy, CAN’T BE AT THE FACILITY or after coming to daycare.

STATE COMPLIANCE ASSESSMENT AND GUIDANCE
- A fever of 100 F or higher for infants younger than 4 months of age, or a fever of 101 F or higher for children age 4 months and older
- An unexplained rash
- Irritability
- Lethargy
- A persistent cough
- Vomiting
- Diarrhea
- Infected eyes with discharge
- Hand, foot, and mouth disease
  If a child becomes ill at Kidsboro Academy, the parents will be notified and expected to pick up the child as soon as possible. Ill children will be isolated from the rest of the children until pick-up. Kidsboro Academy will be okay to receive your child with a running nose or allergy but will require to take medicine to stop or slow down the runny nose or allergy. This will avoid the spread of germs and bacteria.
Kidsboro Academy will be okay caring for your child if he or she has been taking antibiotics for more than 24 hrs. And not contagious if he or she feels well. If Kidsboro Academy feels necessary, it will ask you to take your child to the doctor, and the child will not be able to return to daycare unless a doctor's note is returned explaining the illness.

Provider and all children will practice good hygiene habits given by the Davis County Health Department.
KIDSBORO HOURS OF OPERATION - HOLIDAYS - TARDINESS
Holiday dates may change to accommodate parents with kids who are in school. We will let parents know ahead of time when these holidays are changing and set a new date to replace them or tie them to a different holiday.
DISABILITIES ACT OR ADA

A child with a disability may be denied enrollment or may cancel enrollment after a careful assessment if we notice that we cannot accommodate the children's needs at the academy program.
Here are some of the reasons why we may refuse or cancel service:

1. If integrating a child into the program requires daily changes in policies, practices, or
procedures that will fundamentally alter the program's nature, we may refuse service or cancel enrollment when there is no reasonable alternative.

2. Taking steps to accommodate the child's special needs will dictate excessive weight on the provider or fundamentally alter the program's nature at the academy, and there is no alternative step we can take.
Should be Empty:

Annual Renewal Registration Form

ALLERGIES OR SENSITIVITIES

MEDICATION RELEASE FORM

Read - Checkbox - Sign

VERBAL MEDICATION AUTHORIZATION RELEASE FORM

Medical Release

Transportation Release

Policy & Waiver

KIDSBORO HOURS OF OPERATION - HOLIDAYS - TARDINESS