Blue Spring Academy Registration Form

Blue Spring Academy Registration Form

Are You Ready For Your Little Star To Shine Bright?🌟
Date*

MonthDayYear
Date
Child's Full Name*

First NameLast Name
Child's Age*
Child's Date of Birth*

MonthDayYear
Date
Nickname
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Mother's Name*

First NameLast Name
Cell Number*
Please enter a valid phone number.
Employment Name*
Employment Address*
Address (If Different From Child)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are there any Parent Restrictions?*
If So Please Detail Below
Father's Name

First NameLast Name
Cell Number
Please enter a valid phone number.
Employment Name
Employment Address
Address (If Different From Child)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact 1*
Contact Number*
Emergency Contact 2*
Contact Number*
Pick-up/Release

To ensure each child is returned safely in the care of their families, children will ONLY be released to those listed below. (Only these people will be able to pick up your child from our facility, any changes to this information must be updated with a staff member)*

	Name	Relationship To Child	Number
1
2
3

	Total Daily Hours
Monday
Tuesday
Wednesday
Thursday
Friday

Getting To Know Your Little Star ⭐️
Will This Be Your Child's First Time Attending Daycare?*

YESNO
How Does Your Child React During Seperation From Parents?*
What Is Your Child's Favorite Food?*

Does Your Child Have Any Siblings? If So Please List Them Below

	Name	Age	Gender
1
2
3
4

Does Your Family Practice A Religion? If So Please List Below*
Language Primarily Used In The Home?*
Is Your Child Potty Trained*

YESNO
How Does Your Child Respond To Rules and Redirection On A 1-5 Scale? (1 Being Not Well At All, 5 Being Very Well)*
How Does Your Child Handle Frustration On A 1-5 Scale? (1 Being Not Well At All, 5 Being Very Well)*
How Well Does Your Child Interact With Other Children On A 1-5 Scale? (1 Being Not Well At All, 5 Being Very Well)*
Do You Have Any Behaivor Challenges or Concerns For Your Child?

YESNO
How Can Our Staff Best Comfort Your Child During A Meltdown?*
Are There Specific Skills Or Areas Where You Would Like To See Improvement For Your Child?
Are There Any Other Comments Or Information You Would Like Us To Be Aware Of?

Parental Consent Forms
Photo/Video Consent
At Blue Spring Academy, we often capture moments of our students engaging in activities, learning, and having fun. We try to share these moments with parents via the Brightwheel App. We may use these images and videos for promotional purposes, including our website, social media, and other marketing materials.

I, the undersigned, give my consent for Blue Spring Academy to take photographs and videos of my child (Child's Name) First Name* Last Name* during their participation in activities at the academy. I understand that these images may be used for promotional purposes, including but not limited to:
- Academy website
- Social media platforms (Facebook, Instagram, etc.)
- Newsletters
- Other marketing materials
Date Signed Date*
Mother's Name First Name* Last Name* Signature Signature*
Date Signed Date
Father's Name First Name Last Name Signature Signature
Blue Spring Academy Emergency Transport Consent
I, the undersigned, am the parent/guardian of the child ( Child's Name) First Name* Last Name* . I hereby give my consent for Blue Spring Academy staff to arrange for emergency medical transportation for my child in the event of an emergency.
I understand that:
1. In the case of an emergency, every effort will be made to contact me or the emergency contact listed above.
2. If I or my emergency contact cannot be reached, Blue Spring Academy staff are authorized to take necessary actions to ensure my child's health and safety, including seeking medical assistance and transport.
3. My child will be sent to the nearest hospital for treatment via ambulance.
4. The Director or Staff member will remain with my child until my arrival.
5. I, the parent, am responsible for any costs incurred for medical transport and treatment.
Date Signed Date*
Mother's Name First Name* Last Name* Signature Signature*
Date Signed Date
Father's Name First Name Last Name Signature Signature

Tuition Agreement
This Tuition Agreement Contract is made effective as of Date* ,by and between Blue Spring Academy (the “Provider”) and (the “Parent”) First Name* Last Name* for the enrollment of (the “Child”) First Name* Last Name* .

1.Enrollment: By signing this Agreement, the Parent agrees to enroll the Child in the Provider’s daycare program starting on approved start date.
2.Tuition Fees: The Parent/ Guardian agrees to pay a weekly tuition fee for the Child’s care, which includes your child’s daily provisions.
3.Payment Schedule: Private pay fees are due EVERY MONDAY on a WEEKLY basis. Subsidy Co-Payments are due EVERY FRIDAY on a WEEKLY basis. These fees are payable in advance. Any additional received payment will be added to your child’s next payment.
4.Late Fees: A late fee of $5 per day your child's balance goes unpaid will be charged if payment is not received on the weekly due date.
5.Methods of Payment: Payments can be made via cash, cash app, applepay.
6.Registration Fee: A non-refundable registration fee of $50 is due at the time of enrollment.
7.Early Drop off/ Late Pick-Up Fee: A late pick-up fee of $5 per minute will be charged if the Child is not picked up by assisgned Pick-Up Time or brought in facility earlier than assigned Drop-Off Time.
8.Any additional services requested by the Parent, such as extended care, special activities, or field trips, will incur extra charges. The Parent will be notified of these charges in advance.
9.Notice of Withdrawal: The Parent must provide 2 week written notice to withdraw the Child from the program. Failure to provide this notice will result in a charge for 14 days of tuition.
10.Refunds:Tuition is non-refundable for any unused days or in the event of early withdrawal.
11.Provider’s Right to Terminate: The Provider reserves the right to terminate this Agreement and discontinue services with 14 days’ written notice if the Parent fails to comply with the terms of this Agreement or if the Child’s behavior is deemed disruptive. A same day notice will be given to a parent shall the provider deem the situation immediate termination.
12.Adherence to Policies: The Parent agrees to adhere to all policies and procedures outlined in the Parent Daycare Handbook, which is incorporated into this Agreement by reference.
13.Updates to Policies:The Provider reserves the right to update policies and procedures as necessary. The Parent will be notified of any significant changes. 14.Complete Agreement: This Agreement constitutes the entire agreement between the parties and supersedes all prior negotiations, understandings, and agreements.
Date Signed Date*
Mother's Name First Name* Last Name* Signature Signature*
Date Signed Date
Father's Name First Name Last Name Signature Signature

Individualized Education Plans (IEP) & Individualized Family Service Plans (IFSP) Policy
I, (Parent’s Name) First Name Last Name agree to comply with the IEP & IFSP policy in order to ensure that the needs of my child(Child’s Name) First Name Last Name are fully being met.
Policy Overview
At Blue Spring Academy, we are committed to meeting the unique needs of children with Individualized Education Plans (IEPs) and Individualized Family Service Plans (IFSPs). To ensure we provide the best support for children, we will implement the following procedures:
Procedures
- Request for IEP/IFSP Copies: Families will be asked to complete a request form to provide us with a copy of their child’s IEP/IFSP.
- Confidential Filing: All IEP/IFSP documents will be securely filed in the child’s personal file, ensuring they are readily available for necessary reviews by authorized personnel.
- Goal Sharing and Strategy Discussions: We will provide inspectors with copies of IEP/IFSP goals and engage in discussions about our strategies for achieving these goals.
- Staff Training: Our staff will receive training on the implementation of IEPs and IFSPs to ensure they are equipped to support each child's unique requirements.
- Collaboration with Early Intervention Teams: We will coordinate with early intervention staff and consultants to arrange regular meetings with families and teachers. These meetings will focus on the child’s progress and adapting IEP/IFSP goals to fit classroom activities and routines.
- Progress Monitoring: Teachers will be monitored in their efforts to support children in achieving IEP/IFSP goals, ensuring accountability and effectiveness.
- Additional Support Requests: If necessary, we will seek further assistance from the early intervention team to better support the child’s needs.
- Family Conferences: Teachers will hold family conferences to update families on their child’s progress and discuss any relevant developments.
- Meeting Participation: We will request permission from families to attend any meetings concerning changes to the IEP/IFSP, ensuring transparency and collaboration.
Consent Agreement
I, the undersigned parent/guardian of the child listed above, hereby acknowledge and agree to the following:
- Assessment Procedure: I understand that my child will undergo a 45-day evaluation assessment from the date of enrollment at the daycare facility. This assessment is intended to observe and document developmental milestones, social interactions, and behavioral patterns.
- Assessment Report: I acknowledge that the results of this assessment will be compiled into a report, which will be shared with me. If the assessment indicates that my child may benefit from additional support or further evaluation, I will provide a copy to my child’s primary physician.
- Parental Responsibilities: I agree to cooperate with the assessment process and take any necessary steps based on the recommendations provided in the assessment report. I understand that failure to comply with the assessment process or refusal to act on recommendations may result in the termination of my child’s care at the daycare facility.
- Confidentiality: I acknowledge that all assessment results and related information will be kept confidential and used solely for the purpose of supporting my child’s development. I consent to the sharing of the assessment report with my child’s primary physician as part of the process for further investigation if needed.
- Acknowledgment of Policy: I have read and understood the Daycare Facility 45-Day Evaluation Assessment Policy and consent to the assessment process as described in the policy.
This policy aims to create an inclusive environment where every child receives the support they need to thrive. Thank you for partnering with us in this important process! By signing below, I give my informed consent for the IEP/ IFSP assessment and agree to adhere to the terms outlined above.
Date Signed Date*
Mother's Name First Name* Last Name* Signature Signature*
Date Signed Date
Father's Name First Name Last Name Signature Signature
Should be Empty:

Blue Spring Academy Registration Form

Parent/Guardian Information

Pick-up/Release

Requested Service Information

Child's Healthcare Details

Getting To Know Your Little Star ⭐️

Parental Consent Forms

Photo/Video Consent

Blue Spring Academy Emergency Transport Consent

Tuition Agreement

Individualized Education Plans (IEP) & Individualized Family Service Plans (IFSP) Policy