• Image field 1

  • William A Hunton Child Development Center

  • Operated by William A Hunton YMCA, INC

  • ENROLLMENT PACKET CHECKLIST

  • To enroll children in the William A. Hunton Child Development Center the following documentation
    must be received before the FIRST DAY of service:
  • Received
  • Immunization Record (must contain a typed or handwritten statement from physician or authorizedmedical personnel that child has been properly immunized)

  • Note: Additional documentation of immunizations will be required every six months for children under the age of two years and ONCE between each child's fourth and sixth birthday.

  • Physical: Each child shall have a physical examination by or under the direction of a physician before the child's first day of attendance. (Ages 12 months to age 5 within one month after attendance).

  • ** The William A. Hunton YMCA is committed to a policy of non-discrimination and the promotion of equal opportunities for all persons regardless of age, color, creed, disability, ethnicity, gender, marital status, national origin, race, religion, sexual orientation, or veteran status**

  • This Enrollment Packet Must Be Filled Out Completely

  • CHILD'S INFORMATION (Place N/A in all spaces where non-applicable)

  • Date of Birth:
     - -
  • Sex:

  • PARENT(S) GUARDIAN INFORMATION (Place N/A in all spaces where non-applicable)

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Custody Type
  • *Appropriate paperwork such as custody papers must be on file if a parent is not allowed to pick up the child. Unless a court order has been issued to the contrary, the non-custodial parent of a student enrolled in a public school or daycare center must be included, upon the request of the non-custodial parent, as an emergency contact for events occurring during school or day care activities.

  • Authorized and Emergency Pick-Up

  • Two people to contact if Parent(s) Cannot be Reached: (Must contain complete name, address, and number)
    Please only list individual who are allowed to pick child up when parents can't be reached
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • PERSONS AUTHORIZED TO PICK UP CHILD OTHER THAN PARENTS (Must be at least 16 years of age with Identification)

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Is there anyone whom you do not wish to pick up your child?
  • If so, please give the name and relationship to the child.
  • Is the child's time divided between parents?

  • Background Information

  • Has your child had previous school/day care experience?
  • Rows

  • Describe your child's appetite:

  • Describe your child's appetite:

  • Child's Special Interest:

  • Child's Special Interest:

  • Describe child's behavior traits:

  • Describe child's behavior traits:
  • Does your child exhibit specific fears?
  • Describe child's speech:

  • Arrivals/Pick-Up Procedures:

  • Parents are required to sign in/sign out their children daily. There will be a book to manage this procedure in a designated area. Children must arrive no later than 9:00 a.m. daily. If there is an emergency, please call the center to inform staff at once. Participants are allowed only (2) late call ins per month. All doctor's appointments must be completed no later than 11:30 a.m. with a doctor's note to be admitted for that day.

  • Late Pick-Up:

  • If your child is not picked up by the end of the program day, a late fee will be charged and collected at the time of pick-up. There is a $10.00 late fee for the first (5) minutes and $1.00 every minute after. Late fees are charged per child. If you or any of your emergency contact people cannot be reached within one hour after closing, we will contact Child Protected Services (CPS). Participants are only allowed to remain at the center (10) hours per day. All authorized persons must have valid identification.
  • Image field 92

  • Tuition:

  • The William A. Hunton YMCA Child Development Center charges, by enrollment not attendance. Tuition for services is charged WEEKLY and is payable as pre-arranged. Weekly fees are due on Mondays. Payments can be made weekly, bi-weekly, or monthly by cash or money order. Tuition is not pro-rated if the child is absent. There will be a late charge of $10.00 per week up to a (2) week period. Childcare services will be terminated after the two-week period if tuition is not paid. All delinquent accounts will be transferred to the agency's collection department for processing.
  • Parent Shares/Co-Payments are due on or before the 1st of each month. There will be a $10.00 late fee added if payment is not received by the 7th of each month. Childcare services will be terminated after the 15th if tuition is not paid. Your childcare worker will be notified of failure to pay Co-Payment.
  • Date
     - -
  • Date
     - -

  • Video and Picture Policies

  • The William A. Hunton Child Development uses pictures and videos of our program participants in publications, productions, and on the web. These pictures are used for the following:
    • *Advertisement (news broadcast/agency website/facebook)
    • *Executive Board Program Observation and Review
    • *Staff Training and Development
    • *Special Events Presentations
    • *Community Partnering*
  • We love to be able to include photographs and videos of our talented students engaged in great teaching and learning experiences.
  • has permission to participate in program picture/video/media activities.
  • Date
     - -
  • Date
     - -

  • Field Trip Policy

  • The William A. Hunton Child Development Center will participate in numerous field trips that coordinate with lesson plans.
  • Some of our field trips may require walking.
  • Description of Activities: (i.e., libraries, museums, parks, zoo, walks, movies)
  • Image field 114
  • Date
     - -

  • Water Play Permission

  • The William A. Hunton YMCA Child Development Center may have activities involving water throughout the year incorporated in lesson plans. These activities include, but are not limited to:
    • Water Sensory Table Play
    • Water Bottle Play
    • Sprinkler Play/Slip N' Slide
  • to engage in the water play activities set forth below as sanctioned by The William A. Hunton Child Development Center. I understand that this generic authorization is applicable for all water activities except activities involving water pools.
  • to engage in the water play activities set forth below as sanctioned by The William A. Hunton Child Development Center. I understand that this generic authorization is applicable for all water activities except activities involving water pools.
  • Image field 124
  • Image field 125
  • Date
     - -

  • Permission to Apply Sunscreen

  • Image field 129
  • Image field 130
  • I, ________________________________ (Parent/Guardian Name) do hereby grant permission for the William A. Hunton Child Development Center Staff to apply sunscreen to my child ________________________________ when going outside in extreme heat conditions. I understand that Sunscreen will be applied only in accordance with the manufacturer's recommendations.
  • I, ________________________________ (Parent/Guardian Name) do not hereby grant permission for the William A. Hunton Child Development Center Staff to apply sunscreen to my child ________________________________ when going outside in extreme heat conditions. I understand that Sunscreen will be applied only in accordance with the manufacturer's recommendations.
  • Sunscreen must be in the original container and labeled with the child's name.Sunscreen shall be hypo-allergenic and have a minimum SPF of 15.No expired sunscreen will be accepted.
  • Date
     - -

  • Health and Safety

  • Image field 138
  • The health and safety of your child is of major importance to the William A. Hunton Child Development Center. To protect your child, there are stringent rules that are put in place. These rules follow the Virginia Department of Health and Safety Licensing Regulations. If your child is sick, please keep them at home to avoid contaminating other children and staff. The center is to be notified if your child is going to be out for more than two consecutive days.
  • Temperature: If your child becomes ill at the center, you will be called, and you must arrange for your child to be picked-up immediately. If your child develops a temperature (101° constitutes an elevated temperature), he/she may not return for 24 hours. The child must be fever free without medication.
  • Diarrhea/Vomiting: if a child has 2 episodes within 30 minutes to one hour, the parent will be called to pick up the child. The child must remain home at least 24 hours diarrhea/vomit free before returning to the Academy. We reserve the right to request a doctor's note for any medical absences.
  • If your child becomes seriously ill or is injured at the center, an immediate attempt will be made to contact you or your emergency contact person. If you or your emergency contact are not available, the rescue squad will be called. You will assume any resultant expense not covered by the center's insurance.
  • The school will maintain the parent's signed consent form agreeing to this provision. It is especially important that the center is kept updated with the following information.
  • *Change in Home/Work Numbers
    *Emergency Contact Persons
    *Medical Conditions/Medications

  • Provisions of the Emergency Preparedness and Response Plan

  • Image field 150
  • Image field 151
  • Image field 152
  • The William A. Hunton YMCA Child Development Center assures you that our concern for the safety and welfare of children attending our program is important.
  • Our Emergency Plan provides for response to all types of emergencies. Depending on the circumstance of the emergency, we will use one of the following protective actions:
    • Immediate evacuation- Children are evacuated to a safe area near the center in the event of a fire,
    • Shelter-in-place/lockdown- Sudden occurrences, weather, or hazardous materials in the area may dictate that taking cover inside the center is the best immediate response.
    • Relocation- Total evacuation of the center may become necessary if there is a danger in the area. In this case, children will be taken to a relocation site at
  • We will have your contact information and you will be contacted as soon as possible following any emergency action so that arrangements can be made for you and your child to be safely reunited.
  • In your child's records at this center are the names of people you have authorized to pick up your child if you are not able to do so. Please only send an authorized individual to pick up your child.
  • To assure the safety of your children and our staff, we ask for understanding and cooperation. Should you have additional questions regarding our emergency operating procedures or would like to view our Emergency Preparedness and Response Plan, please let us know.
  • Date
     - -
  • Date
     - -

  • Medical Agreement/Authorization Form

  • I _________________________ do hereby authorize the William A. Hunton Child Development Center to seek medical emergency care for my child, _________________________ if an accident occur necessitating medical treatment and I am unable to be reached. This document shall serve as my authorization for the emergency care physician to administer treatment he/she deems appropriate. Further, I acknowledge my financial responsibility for any treatment rendered in such an emergency.
  • I _________________________ do not hereby authorize the William A. Hunton Child Development Center to seek medical emergency care for my child, _________________________ if an accident occur necessitating medical treatment and I am unable to be reached. This document shall serve as my authorization for the emergency care physician to administer treatment he/she deems appropriate. Further, I acknowledge my financial responsibility for any treatment rendered in such an emergency.
  • **If there is an objection to seeking emergency medical care, a statement should be obtained from the parent(s) or guardian(s) that states the objection and the reason for the objection**
  • 1. The William A. Hunton Child Development Center agrees to notify the parent(s)/guardian(s) whenever the child becomes ill, and the parent(s)/guardian(s) will arrange to have the child picked up as soon as possible if so, requested by the center.
  • 2. The parent(s) guardian(s) authorize the William A. Hunton Child Development Center to obtain immediate medical care if any emergency occurs when the parent(s)/guardian(s) cannot be located immediately.
  • 3. The parent(s)/guardian(s) agree to inform the center within 24 hours or the next business day after his child or any member of the immediate household has developed a reportable communicable disease, as defined by the State Board of Health, except for life Threatening diseases, which must be reported immediately.
  • Format: (000) 000-0000.

  • EMERGENCY INFORMATION (Place None if non-applicable)

  • 1. Allergies or Intolerance to Food, Medication, etc; and Action to Take in an Emergency.
  • 2. Are there any Chronic Physical Problems/Pertinent Developmental Information/Special Accommodations Needed or Behavioral Problems that should be addressed: Ex: (Asthma, ADHD, Diabetic, ODD, Sickle Cell)
  • 3. Does the child have special needs or require special considerations?
  • 4. Does the child have a current IEP?
  • If yes, please provide a copy.
  • Date
     - -

  • Signature Form

  • By signing below, I verify that I have read and understand the information provided in this enrollment packet. I have received a copy of the William A. Hunton Child Development Center's Parent Handbook, and I understand that it is solely for summarizing the center's current policies and procedures and that it is not intended to be a contract or guarantee of my child's enrollment.

  • SIGNATURES

  • Date
     - -
  • Date
     - -
  • *Appropriate paperwork such as custody papers must be on file if a parent is not allowed to pick up the child. Unless a court order has been issued to the contrary, the non-custodial parent of a student enrolled in a public school or daycare center must be included, upon the request of the non-custodial parent, as an emergency contact for events occurring during school or day care activities.
  •  
  • Should be Empty: