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
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:
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:
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:
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
Parent Name:

Parent/Guardian First NameParent/Guardian Last Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Second Phone Number:
Enter if you have oneFormat: (000) 000-0000.
Signature of Parent or Guardian
Date:

MonthDayYear
Today's Date
Upload Immunization Records:

Upload File
Cancelof
Upload a Picture of your Child:

Upload File
Cancelof
DWS Case Number

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.Format: (000) 000-0000.
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.Format: (000) 000-0000.
Child / Children's Address
City
State
County
Zip Code
Emergency contacts and sign out authorization
In the event of an emergency, if the provider is unable to get in touch with me in a timely manner, I give my permission for them to contact the following people. I also give the following people permission to sign my child out from the program.
Out-of-area emergency contact
In the event of an emergency, if the provider is unable to get in touch with me or any of the people listed above in a timely manner, I give my permission for them to contact the following person who lives out-of-area.

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
Tuition and Care Policy:
·   Daily Tuition Coverage: Tuition covers up to 9 1⁄2 hours of care per day, Monday through Friday. A 10-minute grace period will be provided to allow for minor delays or unforeseen circumstances. After the grace period, any time exceeding the 9 1⁄2-hour daily limit will be considered extended care and billed at a rate of $15 per additional hour. Any portion of an additional hour will be rounded up to the next full hour and added to the family account. This fee is separate from any applicable late pickup fees after Academy closing time.
Operating Hours:
· Days: Monday to Friday

· Hours: 6:30 AM to 5:45 PM

· Grace Period: From 5:45 PM to 6:00 PM, parents are allowed a 15-minute grace period to pick up their child without a late fee.
Tardiness / Late Pickup Policy:
·   A late fee of $25.00 will be applied for the first 20 minutes beyond 6:00 PM. After this, an additional fee of $3.00 per minute will apply.
Cancellation Policy:
·   A 30-day written notice is required for cancellations.
Payment Options:
· ACH Payments: No additional fee.

· Credit Card Payments: A processing fee will apply.

· Debit Card Payments: Fees are invoiced separately.

· Payment Due Date: All payments are due on the 1st of each month. A grace period is provided until the 5th of the month. After the 5th, a $50.00 late fee will be applied unless other arrangements have been made with the Academy Director.
Annual Fees and Registration:
· Supply Fee: A $85.00 annual supply fee is charged on January 1.

· Annual Registration: Each year, a new registration form is required by Childcare Licensing. The Academy will send reminders to complete the registration.
Absences and Holidays:
· Tuition: Tuition is still charged even if a child is absent due to illness, vacation, or any other reason.

· Holiday Closures: The Academy is closed on all major holidays. However, if the local school district remains open on certain holidays, the Academy may also choose to remain open. To support our staff, we may substitute that holiday with an alternative day off to ensure they receive a comparable break. Any adjustments to our holiday schedule will be communicated in advance to parents and staff

Holidays

Ø 1: New Year’s Day
Ø 2: Martin Luther King
Ø 3: President's Day
Ø 4: Memorial Day
Ø 5: Juneteenth
Ø 6: Independence Day
Ø 7: Labor Day
Ø 8: Columbus Day
Ø 9: Columbus Day
Ø 10: Veterans Day
Ø 11: Thanksgiving Days
Ø 12: Christmas Day
If a holiday falls on a Saturday, the Academy will close on the preceding Friday. If it falls on a Sunday, the Academy will close on the following Monday

Kidsboro Academy 2026 Holiday Schedule & Accommodations

At Kidsboro Academy, we recognize the importance of holidays for both families and staff. While the academy observes the following holidays, we also make accommodations for families with school-aged children by remaining open on selected holidays. To ensure our teachers still receive their well-deserved time off, we will adjust certain holidays by closing on alternative dates.

Observed Holidays: Holidays that fall on a Saturday will be honored on the preceding Friday, and holidays that fall on a Sunday will be honored on the following Monday.
News Year’s Day - January 1
Martin Luther King Jr. Day - January 19
Presidents Day - February 16
Memorial Day - May 25
Juneteenth - June 19 (adjusted - see below)
Independence Day - July 3
Pioneer Day - July 24 (adjusted - see below)
Labor Day - September 7
Columbus Day - October 12 (adjusted - see below)
Veterans Day - November 11 (adjusted - see below)
Thanksgiving- November 26 (adjusted - see below)
Christmas Day - December 25 (adjusted - see below)

Holiday Adjustment & Accommodations:

To assist families while ensuring teachers receive time off, the following holiday adjustments will be made:

● Columbus Day (October 12, 2026) - Open

○ Instead, the academy will be closed on January 1st & 2nd (New Years)

● Veterans Day (November 11, 2026) - Open
○ Instead, the academy will be closed on November 26th & 27th (Thanksgiving)

● Juneteenth (June 19, 2026) - Open
○ Instead, the academy will be closed on July 2nd & 3rd (Independence Day)

● Pioneer Day (July 24, 2026)- Open
○ Instead, the academy will be closed on December 24th & 25 (Christmas)

Teacher Prep Days:

We wanted to let you know that throughout the year we will be adding a few additional days off for Teacher Prep Days. These days allow our teachers to complete their required training hours and stay up to date with best practices. We appreciate your understanding and support as we continue to provide the best care and learning environment for your children.

● December 31, 2025 - Closing early (at 1 PM)
● April 3, 2026 - Closed for Teacher Prep Day (Closed)
● July 17, 2026 - Closed for Teacher Prep Day (Closed)
● October 16, 2026 - Closed for Teacher Prep Day (Closed)

Summary of Adjusted Closures:
● December 31, 2025 - Closing early (at 1 PM)
● January 1st & 2nd (instead of Juneteenth)
● April 3, 2026 - Closed for Teacher Prep Day (Closed)
● July 17, 2026 - Closed for Teacher Prep Day (Closed)
● October 16, 2026 - Closed for Teacher Prep Day (Closed)
● July 2nd & 3rd (instead of Pioneer Day)
● November 26th & 27th (instead of Veterans Day)
● December 24th & 25 th (instead of Columbus Day)
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.

3. Accommodating the child's needs will require architectural changes that are not
easily done, and there is no reasonable alternative.

4. The child's condition poses a direct threat to the safety or health of other children and
employees in the program, and there is no reasonable way to eliminate the threat
changing policies, practices, procedures, equipment, or services.
Returned Payment / Insufficient Funds Policy

Any payment returned due to insufficient funds (NSF), closed account, stop payment, declined ACH transaction, returned electronic payment, or failed credit/debit card transaction will be subject to a $35 Returned Payment Fee per occurrence.

The returned payment amount, along with the returned payment fee, must be paid within 24 hours of notification. If payment is not received within the required timeframe, childcare services may be suspended until the account is brought current.

After two returned or declined payments within a 12-month period, Kidsboro Academy reserves the right to require all future payments to be made by cash, cashier’s check, money order, or another approved guaranteed form of payment.

Annual Renewal Registration Form

ALLERGIES OR SENSITIVITIES

MEDICATION RELEASE FORM

Read - Checkbox - Sign

VERBAL MEDICATION AUTHORIZATION RELEASE FORM

Medical Release

Transportation Release

Emergency contacts and sign out authorization

Out-of-area emergency contact

Policy & Waiver

KIDSBORO HOURS OF OPERATION - HOLIDAYS - TARDINESS

Allergy Form

Allergy Type

Symptoms to Watch For

Medications & Treatments

Emergency Action Plan

Additional Information