Red Bridge ECC Registration Packet
School Year
For Camp ECC- just enter in Summer and the year
What school year is your child enrolling in? For Camp ECC, just type "Summer" and the year
STUDENT INFORMATION
*Child's Full Name:
*
Check Child Type
New Student
Returning Student
Name used at School:
*Gender:
*
Male
Female
*Date of birth:
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Church Home:
Previous Schooling:
Future Elementary School (if known):
PARENT 1 (PRIMARY CONTACT)
*Name:
*
Same Address:
Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
*Cell:
*
Format: (000) 000-0000.
* Email:
*
*Employer:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
*Work Schedule:
*
*Additional Contact Number (work or home):
*
PARENT 2
Name:
*
Same Address:
Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
*Cell:
*
Format: (000) 000-0000.
* Email:
*
*Employer:
*
* Employer address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
*Work Schedule:
*
*Additional Contact Number (work or home):
*
SIBLINGS
Names and Ages:
Profile of your child
Does your child:
Nap Daily
Suck their thumb
Use a pacifier
Depend on a comfort object
Play well with others
Typical bedtime:
Typical wake up time:
A child's behavior and emotional well-being can be influenced by changes at home. Please let us know if your child is currently experiencing or has recently experienced a transition such as divorce or death (including a pet), separation from a parent, relative or friend, illness in the family, birth of sibling, or any other information you feel would be relevant. This gives us the opportunity to provide special attention your child may need during challenging times. All information will remain confidential.
ADDITIONAL INFORMATION
This is a non-complete list of possible developmental delays or medical concerns. Please check all that apply.
Developmental/Educational Concerns
Speech or language delays
Physical or motor delays
Cognitive or learning delays
Autism spectrum disorder
Medical/Health Concerns
Hearing impairment
Vision impairment
Asthma
Diabetes
Seizure disorder
Bowel/Toileting concerns
Chronic skin conditions
Food allergies
Chronic inner ear concerns
Behavioral/Regulation
Difficulty with attention or self-regulation
Aggressive behaviors (e.g. biting, hitting)
Difficulty with transitions
Anxiety or emotional regulation concerns
Other (please explain below)
Please explain any positive answer above:
*Allergies:
*
Back
Next
CLASSES: CHECK ALL THAT APPLY
Two Years Old:
Monday and Wednesday
Tuesday and Thursday
Friday (This class is offered in addition to the M/W or T/Th
Three Years Old:
Monday and Wednesday
Tuesday and Thursday
Monday Explorers (This class is offered in addition to the T/Th class)
Wednesday Explorers (This class is offered in addition to the T/Th class)
Friday Explorers (This class is offered in addition to the M/W or T/Th class)
Four Years Old/Pre-Kindergarten Class:
Monday, Wednesday, and Friday
Tuesday, Thursday, and Friday
Monday Explorers (This class is offered in addition to the T/Th/F class)
Tuesday Explorers (This class is offered in addition to the M/W/F class)
Wednesday Explorers (This class is offered in addition to the T/Th/F class)
Thursday Explorers (This class is offered in addition to the M/W/F class)
High 5's Class:
Monday, Wednesday, and Friday
Tuesday Explorers (This class is offered in addition to the M/W/F class)
Thursday Explorers (This class is offered in addition to the M/W/F class)
Stay and Play Club:
Monday Stay and Play
Tuesday Stay and Play
Wednesday Stay and Play
Thursday Stay and Play
Back
Next
HEALTH AGREEMENT
Symptoms Requiring Parent Notification and Child Pick-Up
Parents will be contacted and the child must be picked up if any of the following symptoms are observed:
More than one abnormally loose stool
Red or blue discoloration of the face, or high-pitched croup or whooping sounds after coughing
Difficult or rapid breathing
Yellowing of the skin or eyes
Redness, tearing, or irritation of the eyelid lining followed by swelling, discharge, or pus (signs of conjunctivitis/pink eye)
Unusual spots or rashes
Sore throat or difficulty swallowing
Infected skin areas, including crusty, bright yellow, dry, or gummy patches
Unusually dark, tea-colored urine
Gray or white stools
Fever over 99°F
Headache accompanied by a stiff neck
Vomiting
Child is within the contagious period of an illness
Severe itching of the body or scalp, or persistent scratching of the scalp, which may indicate lice or scabies
Please keep your child home if they show any of the above symptoms or have had a fever, vomiting, or diarrhea within the past 24 hours. Notify the ECC office if your child will be absent due to illness and ensure you or an emergency contact can be reached on school days.
*
Agree
Red Bridge United Methodist Church Early Childhood Center does not provide specialized services such as therapy, counseling, or medical treatment. If your child has a medical condition that may require emergency medication, families must provide the necessary medication (e.g., inhaler, EpiPen, Benadryl), along with a Missouri Medical Authorization Form and an Individualized Plan for Children with Medical Health Concerns. These documents inform the school of signs and symptoms to watch for in the event of a medical emergency and provide written permission for staff to administer medication.
Please note that Red Bridge Early Childhood Center may need to communicate with families and, if the program is unable to meet a child's needs, may ultimately dismiss a child from the program.
I have read all the above information and agree with the terms stated.
*
Agree
PICTURE RELEASE
Photo Release – School & Family Use
I give permission for my child to be photographed by Red Bridge United Methodist Church Early Childhood Center for internal and family communication purposes, including classroom art projects, hallway displays, photo albums, and the school's secure parent messaging app used to share updates with enrolled families.
I give permission
I do not give permission
Photo Release - Public Use (Website & Social Media)
I give permission for my child's photograph to be used on the Red Bridge United Methodist Church Early Childhood Center website and official social media platforms (such as Facebook and Instagram). No identifying information about my child will be included with any publicly shared photograph.
I give permission
I do not give permission
Immunization Requirements (No Exemptions)
All students enrolled at ECC must be fully immunized and provide documentation of up-to-date immunization status before attending preschool. No immunization exemptions are permitted. A Missouri Medical Form, completed and signed by a licensed physician, is also required prior to the first day of school.
I have read all the above information and agree with the terms stated.
*
Agree
Back
Next
EMERGENCY CONTACT INFORMATION & CARPOOL AUTHORIZATION
*#1 Name of emergency contact:
*
*Relationship to child:
*
*Phone Number:
*
Format: (000) 000-0000.
*Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
#2 Name of emergency contact:
Relationship to child:
Phone Number:
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
#3 Name of emergency contact:
Relationship to child:
Phone Number:
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
The following names are people that DO NOT have my permission to pick up my child:
AUTHORIZATION FOR EMERGENCY MEDICAL CARE
I understand I will be notified immediately in case of accident or injury to my child. If my child requires emergency medical care, the physician and preferred hospital to be used are:
*Name and Address of Preferred Hospital:
*
*Primary Doctor Name:
*
*Primary Doctor Phone:
*
Format: (000) 000-0000.
*Dentist Name:
*
*Dentist Phone:
*
Format: (000) 000-0000.
*My Insurance Company:
*
*Insurance Policy Number:
*
*Phone:
*
Format: (000) 000-0000.
I also understand that I assume all financial responsibility for injuries sustained by my child while in the care of Red Bridge United Methodist Church Early Childhood Center.
*
Agree
ENROLLMENT AGREEMENT AND ACCEPTANCE OF TERMS
By enrolling my child at the Early Childhood Center (ECC), I acknowledge and agree to the following terms and conditions:
1. I have fully disclosed any medical conditions, special needs, or developmental delays my child may have at the time of enrollment. This information is required to ensure appropriate placement and care. ECC reserves the right to refuse or discontinue enrollment if the program is unable to meet a child's educational or care needs. Additional details regarding these policies are outlined in the Parent Handbook, which is provided electronically upon enrollment.
2. I understand that classes are subject to minimum enrollment requirements and may be canceled if those requirements are not met. In the event of a class cancellation due to low enrollment, families will be notified by August 1.
3. I understand that tuition is due monthly and must be paid by the 10th of each month. A late fee of $15 will be assessed for payments received after the due date.
4. I understand that a minimum of 30 days' written notice is required to withdraw my child from the program for any reason, and that I am responsible for tuition during the notice period.
5. I understand that a completed and signed Medical Examination Report, including documentation of required immunizations, must be on file before my child's first day of attendance. Immunization exemptions are not permitted. I understand that immunization exemptions are not permitted for any child enrolled in or attending this facility.
6. I understand that ECC does not provide transportation for off-site activities, field trips, or excursions.
7. I understand that a copy of the licensing rules for License-Exempt Child Care facilities is available for review at this facility. Red Bridge ECC is a License-Exempt Religious Organization that falls under the rules of the Department of Elementary and Secondary Education in the Office of Childhood.
*Parent/Guardian Signature
*
*Date
*
-
Month
-
Day
Year
Date
Preview PDF
Submit
Should be Empty: