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Child's Name
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First Name
Last Name
Child's middle initial
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Date of Birth
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Month
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Day
Year
Date
Gender
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Please Select
Male
Female
What is your desired start date?
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Month
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Day
Year
Date
Child's Home Address
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Child's Home Phone Number
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Who does this child reside (live) with?
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Mom
Dad
Step Mom
Step Dad
Grandma
Grandpa
Aunt
Uncle
Other
Option 10
Tell us your child's likes.
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Tell us your child's dislikes.
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Are there any custody arrangements in place?
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Please Select
Yes
No
If your child is 2 or older, are they potty trained?
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Please Select
Yes
No
We are trying
My child is not 2 years or older
No but we can start at home AND are ok with the daycare starting potty training.
What do you hope your child will get from our school?
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Parent/ Guardian Information
This section ask for parent(s)/ guardian(s) information.
Parent 1: Name
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First Name
Last Name
Parent 1: Phone Number
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Parent 1: Email Address
Parent 1: Home Address
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Parent 1: Employer Name
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Parent 1: Employer Address
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Parent 1: Work Phone Number
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Parent 2: Name
First Name
Last Name
Parent 2: Phone Number
Parent 2: Email Address
Parent 2: Home Address
Parent 2: Employer Name
Parent 2: Employer Address
Parent 2: Work Phone Number
Medical Information
All enrolling children MUST have a completed HEALTH ASSESSMENT Form. This form must be completed by a physician or medical professional and include your child's Shot Record (Up-To-Date Immunizations). CLICK THE LINK ~HERE~ TO ACCESS THE FORM
Does your child have any of the the following special or dietary needs?
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Allergies (including food allergies)
Asthma
ADHD
Autism
Epilepsy (Seizures)
Emotional Challenges
Behavioral
Nut Allergy
Lactose Intollerance
Other
If your child has a special need, please provide us with some detail.
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Is your child at risk for a MEDICAL EMERGENCY? If Yes, please explain in detail.
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Does your child currently take any medication?
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Please Select
Yes
No
If yes, for what?
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Do you have any concerns about your child's development (speech, cognitive, physical, social, emotional)? If so please descibe:
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Child's Physican Name
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Address
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Phone Number
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Emergency Contacts
Please provide us with three emergency contact persons and their numbers.
Emergency Contact 1 - NameName
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First Name
Last Name
Emergency Contact 1 - Relationship to the Child
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Please Select
Mom
Dad
Step Mom
Step Dad
Aunt
Uncle
Grandma
Grandpa
Brother
Sister
Cousin
Family Friend
Neighbor
Emergency Contact 1 - Phone Number
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Emergency Contact 2 - Name
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First Name
Last Name
Emergency Contact 2 - Relationship to the Child
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Please Select
Mom
Dad
Step Mom
Step Dad
Aunt
Uncle
Grandma
Grandpa
Brother
Sister
Cousin
Family Friend
Neighbor
Emergency Contact 2 - Phone Number
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Emergency Contact 3 - Name
First Name
Last Name
Emergency Contact 3 - Relationship to the Child
Please Select
Mom
Dad
Step Mom
Step Dad
Aunt
Uncle
Grandma
Grandpa
Brother
Sister
Cousin
Family Friend
Neighbor
Emergency Contact 3 - Phone Number
Tution and Financing
Fees can be paid by Check, Money Order, or CashApp. NO cash is accepted
How will you be paying for childcare tuition?
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Please Select
Subsidy (ELRC)
Private Pay
If you recieve ELRC, how much is your co-payment per week?
Enrollment Agreement
Welcome to Robin & Twig Schools. We are committed to providing a safe, nurturing environment where your children can grow to his/her full potential. Your Full Day fee entitles you to 5 or more hours per day of educational childcare, breakfast, lunch and snacks. We believe children should enjoy learning and do so through play and exploration, both individually and in groups. We provide a rich and varied curriculum that gives children choices and teaches them in many ways. The information obtained in this section will be used to develop your child's enrollment agreement including their school schedule.
My Child Will Have a Start Date of:
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Month
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Day
Year
Date
Will your child be attending our school part-time (4 hrs or less) or fulltime?
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Please Select
Part Time
Full-Time
Will Attend The Robin & Twig School on:
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Monday
Tuesday
Wednesday
Thursday
Friday
My child will arrive at:
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Hour Minutes
AM
PM
AM/PM Option
My child will be picked up from daycare at:
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Hour Minutes
AM
PM
AM/PM Option
My child is allowed to be picked up by the following person/ people:
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Please give the first and last names of those who will be picking your child up from daycare.
Does your child need to be picked up/ dropped off from school?
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Yes, Morning Drop-off (ONLY)
Yes, Afternoon Pick-up (ONLY)
Yes, Morning Drop-off & Afternoon Pick-up
No / N/A
If your child needs pick up. drop off from their school, What school?
What times does your child's school begin?
Hour Minutes
AM
PM
AM/PM Option
What times does your child's school end?
Hour Minutes
AM
PM
AM/PM Option
Financial Procedures
Fees can be paid by Money order or Cash-App. No Cash is Accepted. 1) Pay weekly tuition/ co-pay is due every Monday for the current week. If fees are delinquent, my child may not be allowed to attend day care until they are paid. a. If the fee is not received by Monday of the week for which the fee is due, we are required to inform the ELRC office who issued your subsidy. Services will be discontinued if the fee is still unpaid by the date the ELRC sets in writing as the final deadline. b. ELRC will also discontinue services if your fee is late three times within your family’s eligibility year.2) Pay by money order or cashapp ONLY - NO CASH accepted. 3) Pay my regular fee as charged regardless of the number of hours per day my child remains in care. 4) Pay my regular fee as charged regardless of illness, vacation, holidays, in service days, or closings. 5) Pay a late pick-up fee of $15.00 per 10 minutes or portion thereof, if my child is picked up after 6:00 PM. This fee must be paid the morning after the late pick-up or child will not be able to attend until fee is paid.
I acknowledge that I have read and reviewed "Financial Procedures".
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I acknowledge my understanding and agreement to follow all Financial Procedures stated above including my tuition and co-pay amount above..
Signature
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Subsidized Care
I agree to pay my copay and any other excess costs to The Robin & Twig School each week. I understand that subsidized childcare will only pay for five (5) consecutive days absent from care. After the 5th day I will be responsible for the full daily reimbursement rate of tuition for my child(ren) until subsidy resumes. It is required that all subsidized families not exceed more than twenty-five (25) days absent within one (1) fiscal year of July 1 -June 30. If I am absent more than the 25 days allowed, I will be responsible for the full daily reimbursement rate of tuition per day for my child(ren) for any additional days until my renewal on July 1. Subsidized childcare allows for fifteen (15) total holiday, inclement weather or emergency closures per year. If the center needs to close more than the 15 days allotted, I will be responsible for any additional days not covered at the full daily reimbursement rate of tuition for my child(ren). All payments due to The Robin & Twig School are due in the current week to not accrue late fees or balances.
I acknowledge that I have read and reviewed "Subsidized Care."
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I acknowledge my understanding and agreement to follow all Subsidized Care Policies stated above.
Signature
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Health Policies
1) My child will have physical examinations and age-appropriate immunizations in accordance with the American Academy of Pediatric recommendations, which legally qualifies him/her to attend daycare.2) If my child becomes ill during the day, I will arrange for pickup within 1 hour. My child will only return if able to fully participate in the program (i.e. all physical activities including outdoor play).3) Medication will be administered to my child in accordance with the The Robin & Twig School Medication Policy.4) The Robin & Twig School has permission to administer first-aid to my child.5) The center will be notified when my child will be absent for part/full days due to illness, medical appointments or other reasons.6) My child’s medical and allergy information may be posted, discreetly, within easy access of caregiving staff.7) My child’s medical/allergy info may be posted in his/her classroom easily accessible to the teachers.
I acknowledge that I have read and reviewed "Health Policies."
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I acknowledge my understanding and agreement to follow all Health Policies stated above.
Signature
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Other Policies
1) To communicate the following changes promptly to the staff: a. Home or work address and telephone number b. Emergency or escort information including court orders c. Time of drop off/pick-up d. When a person who is not designated on my escort list will pick up my child 2) To provide all the supplies requested on the supply list.
I acknowledge that I have read and reviewed "Other Policies".
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I acknowledge my understanding and agreement to follow all Other Policies stated above.
Signature
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Miscellaneous
1) I will try to attend parent orientation meetings and parent teacher conferences. 2) When requested, I will meet with the Director or other The Robin & Twig School staff members to discuss child or family related issues. 3) I understand that The Robin & Twig School staff actively supervise groups of children at all times. 4) I must provide The Robin & Twig School staff with my child’s IEP or IFSP if they have one, upon enrollment, or at the time one is completed. 5) Parents are expected to behave appropriately toward and our staff while in the daycare setting. 6) Parents are expected to retrain from entering The Robin & Twig School premises in a state of intoxication or under the influence of narcotics. 7) Firearms are never to be brought on the premises of The Robin & Twig School . 8) Children who exhibit behaviors that are deemed unmanageable will be discharged from the program. These behaviors include but are not limited to presenting a danger to self or others, running away, behavior that requires constant individual attention, constantly
I acknowledge that I have read and reviewed "Miscellaneous Policies".
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I acknowledge my understanding and agreement to follow all Miscellaneous Policies stated above.
Signature
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Daycare Consent Forms
Typing your full name is recognized as your valid, digital signature on your child's application.
Transportation Consent Form
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Transportating my child to outside activities including field trips.
Walking/ Transporting my child to/from school.
Transporting my child to obtain emergency medical attention
Walk around the neighborhood
Walks to the neighborhood library or park
Signature
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Photo/Video Consent Form
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I give The Robin & Twig School permission and authority to use, publish, and/ or republish photographic pictures of myself and/or my child. The pictures may be distorted in character or form, in color, or black and white, and may be used for any media solely for the purpose of Future Achievers Childcare Center.
I release The Robin & Twig School and any person(s) or corporation(s) acting under the permission/ authority of Future Achievers Childcare Center from any liability resulting from the distortion, bluffing, altercation, or optical illusion either unintentionally or otherwise, that occurs or is produced in the taking, processing, or reproduction of the finished product, its publication and. or distribution.
I waive my rights to inspect and/ or approve the images/ videos, and/or the finished product.
I have read the above agreement prior to signing below and fully understand the contents.
Signature
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**Complete the Following REQUIRED Documents For Enrollment**
Daycare Enrollment Agreement & Emergency Contact Form. Click: Start Filling, then scroll to complete. At the end of form: CLICK SUBMIT
Additional Documents
Each child needs a health assessment and immunization records. They can be submitted below with the upload feature. Also email ctwiggs@robinschools.org
Child Health Assessment and Shot Records: Required
Medication Log: Please complete if needed.
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For Your Interest In Robin & Twig Schools!
By signing your electronic signature, you acknowledge that all information submitted is true and completed to the best of your ability. You also acknowledge and agree to the school policies stated within this enrollment application. The completion of an enrollment application does not guarantee a seat at our school. The full tuition is payable for each week that your child is enrolled.Shall your child attend, all families and individuals must abide by the rules and regulations set out by Robin & Twig Schools. We strive to provide a positive and enriching environment for all children. Violation of policies and procdures may result in penalties including suspension or withdrawld from our early childhood education program.
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