• Grace Day School Admission Information

    Grace Day School Admission Information

    THIS FORM MUST BE COMPLETED BEFORE THE FIRST DAY OF SCHOOL
  • Grace Day School Lake Highlands
    10101 Walnut Hill Lane 
    Dallas, Texas 75238
     
    Janna Hopkins - Director
    director@gracedayschool.net
     
    Merilee Biancardi - Assistant Director - Registration
    merilee@gracedayschool.net
     
    www.gracedayschool.net
    214-348-9691
  • SCHOOL HOURS: Monday through Thursday, 9:00am - 2:30pm

    This center does NOT provide lunch. Parents are responsible for the nutritional value as described in Minimum Standards for meeting child's daily food needs.

    POTTY TRAINING POLICY: Children who are 3 years of age by 9/1 in the preschool 3s or older classes must be potty trained.

    You Will Need The Following To Complete This Form:

    Your Child's Physician Signed or Stamped Shot Records (That Shows an Examination from the Last 12 Months) or Signed Exemption Affidavit Available for Upload

    Hearing & Vision Test Results Available for Upload, or Signed Exemption Affidavit (for children 4 & older)

    For FOOD Allergies - a Physician Signed FARE Form Available for Upload (Not Needed for Food Intolerances)

    Read the Parent Handbook Located At: www.gracedayschool.net/resources 

    List of Child's Medications

    Physician Address & Phone Number Information, and Emergency Care Facility Address & Phone Number Information

  • Childs Date of Birth*
     / /
  • Child's Gender*
  • Child Lives With?
  • List phone numbers & information below where parents or guardians may be reached while child is in care:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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  • For each parent or guardian where directory inclusion is selected, the adult's name/address/email/cell phone will be listed. I would like to be included in the Grace Day School directory:*
  • Please include the following in the Grace Day School directory:
  • Format: (000) 000-0000.
  • I authorize Grace Day School to release my child to leave the facility ONLY with the following persons in addition to parents/guardian Please list names and phone numbers for each. Children will only be released to a parent or guardian or to a person designated by the parent or guardian after verification of ID via the RAPTOR Security System.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • List phone numbers below where parents or guardians may be reached while child is in care:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date*
     / /
  • CONSENT INFORMATION

  • Water Activities: I give consent for my child to participate in water activities*
  • Water Activities Consent (Check all that apply)*
  • Days & Times In Care:

    Grace Day School offers care Monday through Thursdays 9:00am - 2:30pm and occaisionally on Fridays as noted on our school calendar.  Your child may attend any combination of these days confirmed at registration.

    Children picked up late after 2:30pm may be charged $1 per minute.

  • Receipt of Written Operational Policies: I acknowledge receipt of the Grace Day School operational policies located in the Grace Day School Handbook (www.gracedayschool.net/resources) including those for:*
  • Receipt of Parent's or Guardian's Rights:

    Required information per Chapter 42 of the Human Resource Code (HRC) Section 42.04271. A parent or guardian of a child at a childcare facility has the right to:

    (1)Enter and examine the childcare facility during the facility's hours of operation without advanced notice;

    (2) Review the childcare facility's publicly accessible records;

    (3)Receive inspection reports for the childcare facility and information about how to access the facility's online compliance history;

    (4) Obtain a copy of the childcare facility's policies and procedures;

    (5) Review at the request of the parent or guardian, the facility's: a.Staff training records; and b.Any in-house staff training curriculum used by the facility;

    (6) Review the childcare facility's written records concerning the parent's or guardian's child;

    (7) Inspect any video recordings of an alleged incident of abuse or neglect involving the parent's or guardian's child, provided that:

    a.Video recordings of the alleged incident are available;

    b.The parent or guardian of the child does not retain any part of the video recording depicting a child that is not their own; and

    C.The parent or guardian of any other child captured in the video recording receive written notice from the facility before allowing a parent to inspect a recording;

    (8) Have the childcare facility comply with a court order preventing another parent or guardian from visiting or removing the parent's or guardian's child;

    (9)Be provided the contact information for the childcare facility's local Child Care Regulation office;

    (10) File a complaint against the childcare facility by contacting the local Child Care Regulation office; and

    (11) Be free from any retaliatory action by the childcare facility for exercising any of the parent's or guardian's rights.

  • Date*
     - -
  • Facility Information and Online Compliance History:

    http://txchildcaresearch.org Child Care Regulation Contact Information:  https://www.hhs.texas.gov/services/safety/child-care/contact-child-care-regulation

     

  • Child's Special Care Needs & Past Medical Records (Check All That Apply) Food Allergies is addressed in the next section)
  • Does your child have any diagnosed food allergies: A true food allergy affects the immune system. Offending foods can trigger a range of symptoms which can be severe or life-threatening. A food intolerance often affects only the digestive system and causes less serious symptoms and are not considered food allergies. Celiac disease is not a food allergy.*
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  • 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 in violation of Title III, you may call the ADA Information Line at (800) 524-0301 (voice) or (800) 514-0383 (TTY

  • Date*
     - -
  • Date*
     - -
  • AUTHORIZATION FOR EMERGENCY MEDICAL CARE

    In the event I cannot be reached to arrange for emergency medical care I authorize the person in charge to take my child to:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date*
     - -
  • REQUIREMENTS FOR EXCLUSION FROM COMPLIANCE
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  • VISION EXAM RESULTS - (REQUIRED FOR CHILDREN AGED 4 BY SEPTEMBER 1ST OF THE ENROLLMENT YEAR)

  • Pass or Fail?
  • Date
     - -
  • HEARING EXAM RESULTS (REQUIRED FOR CHILDREN AGED 4 BY SEPTEMBER 1ST OF THE ENROLLMENT YEAR)

  • Hearing Exam Results
  • Rows
  • Date
     - -
  • ADMISSION REQUIREMENT PHYSICIAN OR PUBLIC HEALTH PERSONNEL VERIFICATION

  •   

    These documents are due before the child can attend our childcare program:

  • If your child does not attend pre-kindergarten or school away from the childcare operation, one of the following must be presented when your child is admitted to the childcare operation or within one week of admission (Select only one option)*
  • VARICELLA (CHICKENPOX) VACCINE

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  • Date
     - -
  • For additional information regarding immunizations, visit the Texas Department of State Health Services Website at www.dshs.state.tx.us/immunize/public.shtm

     

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    Under the Texas Penal Code, any area within 1,000 feet of a childcare center is a gang-free zone, where criminal offenses related to organized criminal activity are subject to harsher penalties.

  • Pizza Days are one of Grace Day School's fundraisers. Pizza will be offered for purchase once a month. The days are rotated each month so that we are sure that most of the children will have the opportunity to participate. We suggest sending fruit/sides/drinks on Pizza Days.My child will participate in Pizza Days. If "Yes" selected you will be invoiced by Grace Day School.*
  • I give permission for my child's photographs to be shown on Grace Day School's website Facebook page, newsletters or any other publication.*
  • PRIVACY STATEMENT FROM HEALTH AND HUMAN SERVICES (HHSC)

  • HHSC values your privacy. For more information read our privacy policy online at https://hhs.texas.gov/policies-practices-privacy#security

  • Date*
     - -
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