2025-2026 CHILD REGISTRATION FORM

LITTLE BLESSINGS LEARNING ACADEMY CHILD 2024-2025

REGISTRATION PACKET

Every parent MUST FULLY COMPLETE the Child Registration Packet before being considered for enrollment and accepted at Little Blessings Learning Academy. Once received and reviewed, Little Blessings will call to either confirm acceptance or explain why your child was not accepted at that time.

If your child is accepted, a link will be texted to your phone number to sign up on the Brightwheel App, and a Welcome Message will be sent through Brightwheel (The Parent Handbook will be sent via email). The Welcome Message will include additional information that will be needed before your child can start.

Official start days are always on the nearest Monday, We allot up to 2 weeks to gather the necessary information/ supplies. After 2 weeks of the acceptance call, if nothing has transpired, your child's application will go back into rotation. The sooner the information/supplies are turned in, the sooner your child can start on the nearest Monday.

Name*

First NameLast Name

Age*

Gender*

Date of Birth*

Date

Child's S.S.N.*

Address*

Child's Address

Street Address Line 2

City

Zip

Little Blessings Learning Academy has permission to obtain emergency medical treatment for my child when I cannot be reached and my child is in danger. Insurance Provider:

Insurance Provider*

Member Number*

Preferred Hospital: Does your child have any illnesses or health concerns?

Preferred Hospital*

Does your child have any illnesses or health concerns?*

Does your child have Special Needs? (ADHD, ADD, Autism spectrum disorder, cerebral palsy etc

your child have Special Needs? (ADHD, ADD, Autism spectrum*

Is your child verbal or non verbal?*

Does your child have a therapist? If No, would you be interested in getting one? My child is taking the following medications:

Does your child have a therapist? If No, would you be interested in getting one?*

My child is taking the following medications*

Pediatrician's Name*

Phone*

Pediatrician's Address*

City*

Zip*

Child's Dentist*

Dentist's Phone*

Allergic to: Reaction to allergen: Treatment Required:

Please Note, All Infants bottles are premade, LBLA is not held responsible for ingestion complications due to or aused by consumption/feedings.

Allergic to*

Reaction to allergen*

Treatment Required*

Allergic to: Reaction to allergen: Treatment Required:

Allergic to*

Reaction to allergen*

Treatment Required*

I understand that I assume all financial responsibility for any treatment or injuries sustained by my child while he/she is in childcare.

Parent/ Guardian's Signature: Date:

Parent/ Guardian's Signature*

Date*

Date

Please fill out thoroughly to help the staff get to know your child better as well as understand their personality and daily routines so we can be of better service to them.

Favorite Food(s): Any Dietary Restrictions? Sleeping Habits: Toileting Habits/ Potty Training Progress:

Favorite Food(s)*

Any Dietary Restrictions?*

Sleeping Habits*

Toileting Habits/ Potty Training Progress*

Fears*

Likes*

Dislikes*

Tell us a little about where your child is developmentally*

Are you the Custodial Parent? First Name:

Are you the Custodial Parent?*

Name*

First NameLast Name

Marital Status*

Address*

City: Cell Phone*

City*

Zip*

Email*

example@example.com

Occupation: Employed By: Work Hours:

Occupation*

Employed By*

Work Hours*

Work Address

Work Phone*

City

Zip

Are you the Custodial Parent? First Name:

Are you the Custodial Parent?*

Name*

First NameLast Name

Marital Status

Address*

City: Cell Phone*

City*

Zip*

Email*

example@example.com

Occupation: Employed By: Work Hours:

Occupation

Employed By*

Work Hours

Work Address

Work Phone*

City

Zip

Name*

Relationship*

Phone*

Name*

Relationship*

Phone*

Name*

Relationship*

Phone*

PERSON NOT ALLOWED TO PICK UP CHILD

Name

Relationship

Name

Relationship

Name

Relationship: Relationship: Relationship:

Relationship

LATE TUITION/ NON-PAYMENT INFORMATION

Weekly Tuition is posted every Thursday or Friday and is to be paid by Sunday, the week before service. Billing accounts are checked every Monday. If Tuition is not paid by 9am Monday, it will be considered late. Billing accounts that are late will incur a $10 late fee and will be due promptly (along with the weekly tuition The parent/guardian is responsible for their child(ren)'s outstanding account balance. If by Friday (of the same week) nothing is paid, your child(ren) will be terminated due to non-payment and the outstanding balance will be filed with a collections agency.

I understand that I assume all financial responsibility for the services provided by Little Blessings Learning Academy which includes but is not limited to: registration fees, tuition, late fees, uniform shirts, transportation, co-pays. I understand that non-payment will result in termination, as well as, the account balance being given over to a collections agency.

Parent/Guardian Signature: Date:

Parent/Guardian Signature*

Date*

Date

LATE DROP OFF/ (LATE PICK UP INFORMATION

Child drop off is from 6 AM to 9 AM Monday to Friday. Children who have a doctors/dentist appointment that morning are permitted with an excuse stating the child was seen in the office that morning.

LBLA offers care as early as 5AM with an additional fee of $10. per day. As well as extended after care hours, from 6pm to 8pm with an additional cost of $20. per day.

If you are late picking up your child, a $10. late pick up fee will be charged after 6 PM and $2. each additional minute after. This fee could be waived if you run across an issue that is out of your control such as: traffic due to an accident or severe weather conditions. If that is the case, please call the front office (985-224-8148) as soon as possible.

If there are no prior communications made by the parent/guardian concerning late pick up. Office Administration will call the parent/guardian first, and any approved pick up person second If there is no response from those listed on the Child Registration Packet, the police and CPS will be called.

Parent/ Guardian Signature: Date:

Parent/ Guardian Signature*

Date*

Date

INFORMATION. RECORDING(S), OR PHOTOGRAPH(S) CONSENT

I give my consent for Little Blessings Learning Academy to release information/ photographs/ recordings of my child from which my child might be identified, except to authorized state and federal agencies.

Date*

Date

Parent/ Guardian's Signature*

My child*

has my permission to watch "PG" programming.

Date*

Date

Parent/Guardian's Signature*

TIME OUT AUTHORIZATION

I understand that one of the behavior management tools this facility uses when a child misbehaves is time out. The facility's usual policy when placing a child in time out is not to exceed one minute per their age. For example: 2 years old = 2 minutes of time out. 3 years old = 3 minutes of time out. If my child is over 6 years old, I am giving permission for Little Blessings Learning Academy to place my child in time out for a period not to exceed ___6__ minutes, should his/her behavior warrant this.

Date*

Date

Parent/ Guardian's Signature*

WATER ACTIVITIES & On Site Fieldtrips

My child has my permission to participate in the following type of water activities: Outdoor "water day" including sprinklers, water slides, and water balloons. Most water activities will be located at Little Blessings Learning Academy (320 Belle Terre Blvd. Laplace, LA, 70068 I understand that if my child uses earplugs when participating in water activities, he she must be able to insert earplugs themselves. Staff is not permitted to put earplugs into a child's ear.

On Site Fieldtrips are events and activities held on the premisses or wih walking distance of LBLA. By signing you give consent for your child to participate in these events and activities.

Parent/ Guardian's Signature*

Date*

Date

ADDITIONAL REGULATIONS

We at Little Blessings Learning Academy continually strive to provide excellent and professional care to you and your children. Our ability to do so is contingent on working together with you, the parent/guardian. To be on the same accord and to prevent any misunderstandings, we ask that you carefully read the Additional Regulations below.

If your child has a history of biting or has bitten another student resulting in an open wound, then he/she will be automatically unenrolled and terminated.
If you have been spoken with in regards to your child bullying another and that behavior persists, he she will be automatically unenrolled and terminated (Our first option is to work together towards a solution).

If you have been spoken with in regards to your child's frequently disrupting behavior in class (included but not limited to: fighting staff or children, offensive language etc, he/she will be automatically unenrolled and terminated (Our first option is to work together towards a solution).

Parents are not allowed to disrespect, use offensive language, or fight with staff members at any time; doing so will result in automatic termination of your child(ren), and being escorted off the premises by police and banned from returning.

Uniforms are mandatory for all children. (uniforms for all ages ranges from 6 weeks to 5T can be purchased from the front office). A child not in full uniform may get turned around.

Brightwheel is the main means of communication from the staff to the parents/guardians, so please check your Brightwheel throughout the day.

Parent/Guardian's Signature*

Date*

Date

PARENT/GUARDIAN INFORMATION

PRIMARY PICK UP OTHER THAN PARENT (PHOTO ID REQUIRED)