Required Enrollment Form for Children Ages 6 Weeks to 6 Years

Thank you for taking the time to complete this important information. This form contains questions about your child's basic health and immunization information, and consent and release statements in order to participate in our program.

All children/infants are required to have this form completed before they may attend Milestones Academy of Texas each year, but please keep in mind that there may be other required forms for you to complete, such as a Medical Action Plan if your child has a diagnosis that requires employees to be prepared for emergency medical treatment should something happen.

This form takes about 20 minutes to read through and complete but it can be saved for submission at a later date/time.

If you have any questions, please email us at registration@milestonesacademytx.com.

Birth Certificate

Children new to our school must submit the child's original birth certificate (passport is also accepted). Submit the document in-person to the school office. A staff member will copy the document for you.

Please note that if you have to order a birth certificate, it can take up to one month in Texas for one to be delivered via mail. You can order a birth certificate online at the Texas Vital Records website. Please contact us if you are still waiting on your certificate.

Milestones Academy of Texas seeks to provide the most safe and effective care for each child enrolled in the infant class. In order to provide that care, this facility has established the following policies to help staff and parents work together for the benefit of each child. The facility’s policies may be stricter than choices made at home, but please understand that this is to establish standards that are clear and safe for all children in MAT’s care.

A proper feeding guide allows for a gradual introduction of solid foods and encourages breast feeding or formula feeding up to the first birthday. The texture and amount of the feeding should be consistent with the age of the infant. For emotional, nutritional and physical growth, infants need foods that are rich in nutrients. Foods such as strained meat, fruit, vegetables, iron-fortified dry infant cereal, iron-fortified infant formula, and breast milk provide the maximum amount of vitamins and minerals for growing babies. Teachers and Parents should communicate clearly and consistently regarding important feeding routines and expectations in order to coordinate the best care for the child.

• Breast milk or infant formula provided by the infant’s parent will be served according to the Infant Feeding Plan, which should be completed by the parent, and updated as often as necessary.

• Whole milk may not be served to infants under 12 months old. Consumption of whole milk can lead to iron deficiency. High levels of calcium and phosphorous and the low level of vitamin C in whole cow’s milk may inhibit an infant’s ability to absorb iron from other foods. Furthermore, whole cow’s milk has been shown to cause microscopic bleeding and nutritionally significant blood loss, thereby promoting the development of iron deficiency anemia. *Exception: Whole milk will be allowed instead of iron-fortified infant formulas or breast milk if there is a signed medical statement on file.

• One hundred percent fruit juice is approvable only at snack from eight months up to the first birthday. Juice should not be offered to infants until they are ready to drink from a cup. Drinking juice from a bottle can promote tooth decay. Never prop a bottle or give a bottle to a baby during nap time. This can cause choking as well as tooth decay and ear infections.

• Solid foods are optional and should be introduced only if the infant is developmentally ready.

o Note: Please do not send in fortified adult cereals as a substitute for the iron-fortified dry infant cereal for infants. Adult cereals do not provide infants with the same kind of easily absorbed iron as the iron-fortified infant cereals do. In addition, adult cereals often contain added sugar or salt. Sending in adult cereals for older infants who can safely consume the food item, will only be served as a snack.

o Solid foods should be cut into very small bites before being sent to preschool.

o Infant teachers may ask that certain foods not be brought at all to the preschool in order to better facilitate feeding several infants throughout the day.

• This facility does not provide milk or food for babies. The parent is responsible to provide all milk bottles, meals, snack, and juice cups at drop off each morning. The preschool will not store milk for students.

• All bottles need to be prepared for the day. Snacks and food must be ready to serve. MAT will not microwave food or bottles.

• Bottles will be submerged in warm water from the sink to warm.

• Only bottles will be refrigerated. All other food, snack and juice should be packed in a lunchbox with an ice pack, if necessary.

• All bottles, snack cups, feeding utensils, and bibs need to be labeled.

• Please take the time each morning to provide updated information to the teachers, as is applicable, and make sure it is written down for teachers to reference. Parents may be asked to update certain forms on a monthly basis or as the child’s needs change.

Sudden Infant Death Syndrome (SIDS) is the unexpected death of a seemingly healthy baby for whom no cause of death can be determined based on an autopsy, an investigation of the place where the infant died, and a review of the infant’s medical history.

We believe that a safe sleep environment for infants helps lower the chances of an infant dying from SIDS, and that parents and child care providers can work together to provide a safe sleep environment. Milestones Academy of Texas (MAT) will implement the following safe sleep practices even though we are not a licensed facility.

Safe Sleep Practices
1. All child care staff caring for infants and child care staff that may potentially care for infants will receive training on how to implement our infant Safe Sleep Policy.

2. Infants will always be placed on their backs to sleep. Exceptions will only be made for children who are six (6) months of age or under if there is a signed Alternate Sleep Position Waiver- Health Care Professional Recommendation in the infant’s file. A child’s waiver notice will be posted by the facilities cribs. If your child is over six (6) months old, this facility will accept the Alternate Sleep Position Waiver –
Parent Request, which must be properly completed, signed and submitted in order to place your child down on his/her side or stomach. Waivers will be retained in the children’s record as long as they are enrolled.

3. When babies can easily turn over from the back to the stomach, they will be placed to sleep on their backs and then allowed to adopt the sleep position they prefer. This is in accordance with the American Academy of Pediatrics (AAP) recommendations. Child care staff can further discuss with parents how to address circumstances when the baby turns onto their stomach or side.

4. Sleeping infants will be visually checked daily, every 15-20 minutes, by assigned staff. The sleep information will be recorded on a Sleep Chart. The Sleep Chart will be kept on file for one month after the reporting month. We will be especially alert to monitoring a sleeping infant during the first two weeks the infant is in child care. We will check the infant for:
• Normal skin color
• Normal breathing by watching the rise and fall of the chest
• His or her level of sleep
• Signs of overheating: flushed skin color, increase in body temperature (touch the skin), and restlessness

5. Staff will reduce the risk of overheating by not over-dressing or over-wrapping the infants.
6. All parents/guardians of infants cared for in the facility will receive a written copy of our Infant/Toddler Safe Sleep Policy before enrollment, will review the policy with staff, and sign a statement saying they received and reviewed the policy.

7. The temperature in the room where the infant(s) sleep will be kept between 68-75°F.

8. To promote healthy development, awake infants will be given supervised “tummy time” for exercise and for play.

Safe Sleep Environment
9. Infants' heads will not be covered with blankets or bedding. Infants' cribs will not be covered with blankets or bedding. We may use a sleep sack, if provided by parents, or children may be swaddled.

10. No loose bedding, pillows, bumper pads, etc. will be used in cribs. We will tuck any infant blankets in at the foot of the crib and along the sides of the crib mattress.

11. Toys and stuffed animals will be removed from the crib when the infant is sleeping.

12. Pacifiers will be allowed in infants’ cribs while they sleep. When the pacifier falls out of the sleeping infant’s mouth, it will not be reinserted into the infant’s mouth. The pacifier is the only object we will allow in a crib.

13. A safety-approved crib with a firm mattress and tight fitting sheet will be used.

14. Each infant will have his or her own crib sheet to use each time s/he is resting. Only one infant will be in a crib at a time, unless we are evacuating infants in an emergency.

15. No smoking is permitted in the infant room or on the premises.

We put babies down to sleep on their backs. If you desire the teachers to put your child down in a different position, please complete the appropriate form for the child’s age. The “Doctor Request” form must be completed by a physician for children under 6 months old. The “Parent Request” form only needs a parent signature and is for children 6 months old and older.

If you need to update Emergency Contact information, log in to the Parent Portal once you receive notification to create your login credentials, and then edit your child's record.

Make sure to let your emergency contacts, and anyone else who may pick up your child, know they must bring a photo ID with them to show the child's teacher before they will be allowed to pick up the child.

Consent for Emergency Medical Treatment and Use of External Preparations, and Release of Liability

In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give the representatives of Milestones Academy of Texas permission to act on my behalf to give emergency treatment, hospitalize, secure proper treatment and/or order an injection, anesthesia or surgery for my child in the event that such treatment is deemed necessary by the physician, dentist, paramedic, EMT or other skilled medical practitioner selected by the representatives of Milestones Academy of Texas. I give permission to those administering emergency treatment to do so, using those measures necessary.

I attest to my understanding of and agree that I am giving Milestones Academy of Texas permission to use all of the external preparations that I selected above on my child, in accordance with the directions for use on the container.

My submission of this form constitutes my agreement not to hold Milestones Academy of Texas, its agents, representatives or employees liable for damages, losses or injuries to person or property. Furthermore, I agree to update emergency contact information and medical information regarding my preschooler without delay should such need arise. I understand that I am submitting this form for the minor listed on this form, and I further understand that my submission of this form constitutes a full and complete release from liability insofar as Milestones Academy of Texas is concerned.

By entering my name in the box below, I understand and agree to all aspects, terms and conditions of the above Emergency and Medical Information section, Consent for Emergency Medical Treatment and Use of External Preparations, and Release of Liability, including all of its acknowledgements, statements, policies and procedures, and I further agree that all entered information is true and accurate to the best of my knowledge.

Use the file upload option below to submit a copy of your child's most recent immunization record. Please do not wait to request these from your child's doctor since records requests can sometimes be delayed.

Your child will not be allowed to attend his/her class until Milestones Academy of Texas has received your child's immunization record, which is due by the enrollment date. If enrolling late, please submit these forms on or before your child's first day of school.

Tuition will not be prorated and no refunds will be made for days missed due to incomplete or immunization records that have not been received.

By entering my name in the box below, I understand and agree to all aspects, terms and conditions of the above Immunization Records, including all of its acknowledgements, statements, policies and procedures, and I further agree that all entered information is true and accurate to the best of my knowledge.

Financial Commitment Acknowledgements

By completing and submitting this form, I understand and agree that my financial commitment to Milestones Academy of Texas includes all the financial policies outlined in the Parent Handbook and that Financial Acknowledgements 1-8 below are not exclusive to the policies and procedures regarding my financial commitments. I understand and agree that I must make timely payments of a registration fee, monthly tuition fees, activity fee, other fees as explained in the handbook, and optional fees, such as Scholastic book orders, etc.

1. Registration Fee

I understand and agree that the registration fee is non-refundable, unless the child’s name is placed on a Milestones Academy of Texas waiting list and the parent requests a refund prior to an opening in a class. The registration fee is not part of tuition for the coming school year.

2. Tuition and Transaction Fees

a) I understand and agree that my child is enrolling for the entire school year and that tuition is based on an annual fee, paid in nine installments, and is not a fee per day or a fee per month. Refunds will not be given for illness, holidays, inclement weather, vacation, scheduled breaks, behavioral suspensions, and/or withdrawal.

b) I understand and agree that tuition is due by the first day of each month starting with the August tuition payment. Payments are due EACH month through April. Payments will be considered late after the 15th of each month and an automatic late fee of $25.00 will be assessed each time a payment is not received on or before the 15th of each month (August through April tuition payments). The late fee payment is to be included with my late tuition payment. All fees past due after 30 days will make my child subject to suspension until payment is made. This could also result in dismissal of the child from the program. I will speak to the Financial Assistant before the 15th of each month if I need to request special payment arrangements.

c) I understand and agree that tuition payments may be paid online through the Parent Portal (preferred method), or with cash or checks. I agree to follow all payment procedures specific to the payment type as outlined in the Parent Handbook. Furthermore, I agree to NOT give my payments to my child’s teachers or send it in with my child. I also understand and agree that new families must pay tuition payments by cash or check until given their login information to the online parent portal, which is distributed either at Parent Orientation or the child’s first day of school.

d) Credit and debit card payments made through the Parent Portal for any fee will incur a Transaction Fee of 2.9% plus $0.30 per transaction. The transaction fees are subject to change. Parents will receive a 30 day notice prior to a Transaction Fee change. ACH (i.e. E-checks or Direct Debit) payments through the Parent Portal do not incur processing fees.

3. Activity Fee

I understand and agree that the activity fee is non-refundable and is due by the last school day of October, or a late enrollee’s first day beginning November 1. The fee may be split into three equal installment payments (August-October). Late enrollees may make payment installment arrangements with the Financial Assistant at the time of enrollment. I understand that more details regarding the activity fee are outlined in the Parent Handbook and I agree to abide by all terms as explained in the Parent Handbook.

4. Late Pick Up

I understand and agree that I may be charged $1 per minute if I am late more than 10 minutes to pick up my child. Payment is due the next day of class.

5. Voluntary Withdrawal

I understand and agree that if I decide to withdraw my child, a thirty (30) days written advance notice is required (the 30 days begin the date Milestones Academy of Texas receives the notice). Children are considered enrolled for the entire year; therefore, budgets and teacher contracts are set accordingly. A $25 fee will be assessed on my account if my written notice to withdraw is less than 30 days. If my child is voluntarily withdrawn from the program after I have paid the next month’s tuition fee, the tuition payment applied to the month in which my child will not attend may be refunded if-

1) The school receives written notice of the withdrawal from me, and

2) I inform the preschool office of the address to which the refund check should be mailed. The refund check will be issued, less any fees that may have been incurred (i.e. outstanding tuition balance, late fees returned payment fees, etc.). It may take up to four weeks to receive the refund check.

6. Involuntary Dismissal

I understand and agree that non-payment of fees, including fees past due after 30 days, subjects my child to dismissal from the program. If my child is dismissed from Milestones Academy of Texas, tuition is neither refundable nor pro-rated and cannot be allocated to the accounts of siblings. In addition, the full month's tuition is due for any month in which my child attends one school day.

NOTE: See the Milestones Academy of Texas Handbook for an explanation of other reasons a child may be dismissed from Milestones Academy of Texas.

7. Returned Checks

I understand and agree that a $25 fee will be assessed on all returned payments. After a second returned payment, all future tuition payments must be made in cash or cashier’s checks drawn on a local bank or a bank that has a local branch. Milestones Academy of Texas reserves the right to refuse any cashier’s checks. Do not submit money orders for payment.

8. Outstanding Balance

I understand and agree that re-enrollment will not be allowed and child evaluations and/or references may not be released with an outstanding balance remaining at Milestones Academy of Texas.

Milestones Academy of Texas Parent Handbook Acknowledgement

I acknowledge that I have thoroughly read the Milestones Academy of Texas Parent Handbook (available at www.MilestonesAcademyTX.com), and that I fully understand and agree to uphold the policies and procedures as they are outlined. I agree to communicate with the administrative staff any questions or concerns I have in a timely manner so that issues can be addressed as soon as possible.

Teacher Requests

I understand and agree that no request for a specific teacher will be taken for the school year. Each child will be placed by the Milestones Academy of Texas Leadership Team.

COVID-19 Response Parent Handbook Addendum

I understand that an addendum to Milestones Academy of Texas' (MAT) Parent Handbook has been created for the 2022-2023 school year to address policies and procedures that may have changed due to our response to COVID-19. I understand and agree that the COVID-19 Response Parent Handbook Addendum supersedes any policy and procedures in the (MAT) Parent Handbook that may seem to conflict.

I acknowledge that I have thoroughly read the COVID-19 Response Parent Handbook Addendum (available at www.MilestonesAcademyTX.com), and that I fully understand and agree to uphold the policies and procedures as they are outlined. I agree to communicate with the administrative staff any questions or concerns I have in a timely manner so that issues can be addressed as soon as possible.

I understand that administration will inform parents if other COVID-19 responses are developed and implemented in the course of the 2022-2023 school year and I agree to fully abide by them. Administration will also inform parents when MAT is able to revert back to operations as outlined in MAT Parent Handbook.

I further agree to make it a priority to read all communication that is sent home with children throughout the year and emailed to the address we have on file to stay informed about these possible changes.

By entering my name in the box below, I understand and agree to all aspects, terms and conditions of the above Parent/Legal Guardian's Commitment to Policies and Procedures section, including all of its acknowledgements, statements, policies and procedures, and I further agree that all entered information is true and accurate to the best of my knowledge.

Student Directory Release and Consent Statement

Milestones Academy of Texas may create or provide a student directory for each class. This list will be distributed only to other families in the weekday school. The child’s name, home address, parent/guardian’s name, email, and phone number will be included in the directory.

Image Release & Consent Statement

By submitting this form I hereby grant permission to Milestones Academy of Texas, its assigns, licensees and successors the right to use photographs and/or video taken of my child for any use, including advertising, trade, or any commercial purpose. I understand that no personal information about my child will be published. I hereby waive any right to inspect and or approve the finished photographs or video or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photographs and/or video. I understand that all images and recordings will be used in a positive manner.

Therefore, I agree to release, indemnify, defend, and hold harmless Milestones Academy of Texas, and staff, volunteers, employees, agents, successors, and assignees (the “Indemnified Parties”) from and against any claims, damages from and against any and all claims and/or liabilities resulting from this publishing, including, but not limited to any misuse, distortion, blurring, alteration, optical illusion, or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.

I understand and agree that this consent does not have an expiration date. We understand that in order to nullify this consent, we must notify Milestones Academy of Texas in writing via mail or email. If any of the above-mentioned items for which we previously granted permission for publication have already been used in any publication (digital, audio, visual, print, etc.) prior to our letter, the preschool and/or church may and will still distribute the publication(s) (digital, audio, visual, print, etc.). However, use of our image and/or names in future publications (digital, audio, visual, print, etc.) will cease after the preschool and/or church’s receipt of our letter expressing our desire to void this consent.

Participation Release and Consent Statement

In planning and preparing for events, Milestones Academy of Texas has carefully and methodically planned for a safe and successful event. However, no activity or event is without the possibility of unforeseen hazards. Certain activities have the inherent possibility for risk. Therefore, we want to alert parents, guardians and other individuals to these risks. By submitting this form the parent, guardian and/or individual agrees to assume and accept all risks and hazards associated with these events. These include but are not limited to, sports, water activities, science experiments, and all health and safety hazards associated with these events. The parent, guardian and/or individual also agrees not to hold Milestones Academy of Texas and/or its agents, representatives or employees liable for damages, losses or injuries to the person named on this form.

By entering my name in the box below, I understand and agree to all aspects, terms and conditions of the above Identifying Information Release and Consent section , including all of its acknowledgements, statements, policies and procedures.

By entering my name in the field below and submitting this form -

1) I attest to my understanding of and agreement that I am signing this form and the entry will be used as my signature.

2) I attest to my understanding of and agreement to abide by all acknowledgements and statements, and their terms and conditions, made in this form and the Parent Handbook and COVID-19 Response Addendum.

3) I understand and agree that required forms that are due in addition to this form, must be submitted as directed.

4) I certify that the information contained in this form is true and accurate. Furthermore, I attest to my understanding of and agree that by providing false information could result in termination of services and forfeiture of all paid fees.

Enter your first and last name below to sign this form and indicate that you are authorized to make decisions for this child.