Enrollment Application

1. Childcare betweenA.M./P .M. toA.M./P .M. for______________ ___ _days per week as prearranged, excluding days the center is closed. 2. The child shall be given breakfast if arriving before 8:00 A.M., lunch between 11:00 A.M.-12:00 P .M.(not provided by center),and a mid-afternoon snack for children who are at the center after 2:00 pm. 3. The child shall be given assistance with personal care as needed. 4. The child will be provided with an opportunity to nap between 12:30-2:30pm on a cot or crib provided by the center. 5. The child shall be placed in a group of peers based on age and/or special needs, as determined by the staff. 6. The child will be involved in a program of learning experiences and play, which are appropriate for the ages of the children enrolled in the center. A balance of active and quiet play is provided for, with individual and group activities, which are geared toward the emotional, social, physical, and individual growth of young children. 7. The center shall assume responsibility for the child after the parent signs in the child and has notified the teacher. The center shall retain responsibility until the child is signed out by the parent, guardian, or designated representative of the child’s parent or guardian. 8. The child shall be administered physician prescribed medication only upon the written daily request of the child’s parent or guardian. The center shall not administer a non-prescription medication unless it is accompanied by a written daily request from the child’s parent or guardian. The center shall have no responsibility of any kind whatsoever, neither for failure to provide requested prescription medication nor for adverse reaction, which may be caused by the administration of such prescription medication. 9. The center shall give appropriate first aid to an injured child. A parent or guardian shall be contacted if it is the judgment of the staff that immediate medical attention is necessary. If it is the further judgment of the staff that the injury is of an emergency nature, paramedics shall be called to the school and a parent or guardian shall be contacted. 10. An ill child shall be isolated and given appropriate care until called for by a parent, guardian, or a designated representative. 11. The center shall notify the child’s parent or guardian of a suspected exposure to a communicable disease. 12. The center shall make every effort to safeguard personal belongings brought by the child, but shall not be responsible for lost or broken items. 13. The Directors or any other staff members shall report to Children’s Protective Services of the Police Department, of any suspicion of child abuse, sexual or otherwise, neglect, or endangerment of which they may become aware. State law mandates this. PAYMENT PROVISION In accordance with the statement of fees in the parent handbook: 1. A non-refundable registration fee shall be paid upon enrollment. 2. Tuition Fees shall be paid on the first day of the week in which care will be given. A late fee of $5.00 per day shall be added for late payments. 3. Two weeks notice shall be given to the center before withdrawing from the program. If notice is not given, parent or guardian is responsible for two weeks tuition. 4. Each full time (4-5 days per week) enrollment in the program is given one week of vacation in which tuition will not be due for absence. The center shall be notified one week prior to vacation.OBLIGATION OF PARENT OR GUARDIAN1. A parent or guardian shall furnish requested medical information not more than 15 days after enrollment. 2. A parent, guardian, or designated representative of the child’s parent or guardian shall bring the child into the center upon arrival and sign in on the appropriate register. 3. A parent, guardian or designated representative of the child’s parent or guardian shall sign the child out on the appropriate register and notify the teacher before taking the child from the premises. 4. The parent or guardian shall notify the center when someone other than those names on the emergency information card will be picking up the child. 5. The parent or guardian with a child attending during nap time (staying at the center after 12:30pm) are required to bring 1 crib sheet and a small blanket. 6. The parent or guardian shall see that the child is dressed appropriately when brought to the center. 7. The parent or guardian shall notify the center of the child’s possible exposure to a communicable disease. 8. The parent or guardian shall notify the center when the child is to be absent. 9. The parent or guardian shall abide by the parking rules of the center. 10. The parent or guardian shall notify the center when signing in if there is a change in the child’s daily schedule. 11. The parent or guardian shall refrain from reprimanding children while on the premises. 12. The parent or guardian shall come to the center for conferences when asked to do so by a member of the staff. TERMINATION OF AGREEMENT This agreement can be terminated in any of the following circumstances: 1. Serious illness of the child, preventing attendance. 2. The parent or guardian of the child allows their account to become delinquent. 3. Failure of the parent or guardian to honor the obligations listed in this agreement or in any rules, regulations or manuals provided by the center. 4. The center in its sole discretion determines that it is unable to meet the needs of your child. 5. The center in its sole discretion determines that it is not in the best interest of the center or the other children enrolled at the center, to have the child in attendance. 6. Failure of the child’s parent or guardian to cooperate with the center, which the center determines in its sole discretion, is serious enough to warrant termination.

I hereby grant permission for my child to use all of the play equipment and participate in all of the activities of the center, and to leave the center premises under the supervision of a staff member for neighborhood walks or for field trips in an authorized vehicle. This includes using areas included in the property surrounding the center.I hereby grant permission for the Director or Acting Director to take whatever steps may be necessary to obtain emergency medical care. These steps may include, but are not limited to, the following: 1. Attempt to contact a parent or guardian, the child’s physician, or the persons listed on the emergency information form. 2. If we cannot contact you or your child’s physician, we will do one or both of the following: a. call another physician or paramedics have a child taken to an emergency hospital in the company of a staff member. 3. Any expenses incurred under 2, above, will be born by the child’s family. 4. The center will not be responsible for anything that may happen as a result of false information given at the time of enrollment. 5. The center WILL NOT assume responsibility for a child who has not been signed in upon arrival for the day. MEDICAL AUTHORIZATION: The undersigned, who are the parent(s) or guardian(s) having legal custody of the above named minor, hereby authorize the above named child care center, into whose care the above named minor has been has been entrusted, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care to be rendered to said minor under the general or special supervisor and upon the advice of a physician and surgeon licensed under the provision of the Medical Practice Act, or to consent to an x-ray examination, aesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to said minor by a dentist licensed under the provisions of the Dental Practice Act.The undersigned further authorize the above named childcare center to have the above named minor released into custody of its representative, should hospital care no longer be required. This form is to be used ONLY in an extreme EMERGENCY , when said parent(s) or guardian(s) who cannot be contacted or are unavailable