Application for Admission - Summer Day Camp

- General Information
  - Classes run Monday, June 22nd – Thursday, July 30th
  - Children may be dropped off from 8:00 a.m. - 9:00 a.m.
  - Uniforms are not required for Summer Day Camp.
  - Classes will be filled on a first-come, first-serve basis.
  - Parents must provide lunch, morning snack and spill proff water bottle for their child.
  - Kindergartners, 1st & 2nd Graders who aren't currently enrolled at DELC must submit a copy of a current physical dated after 8/1/24.
  New Preschoolers
  - New Preschoolers must be enrolled at the Dearborn Early Learning Center for the 2026-2027 School Year.
  - New Preschoolers must submit a physical prior to starting Summer Day Camp and must be dated after 6/22/25.
  - 1/2 Days are only available for preschoolers who are new to DELC
  - Child must be 3 by 9/22/26 to attend Summer Day Camp.
  - Children must be Potty Trained. Potty Trained is defined as "A child is able to verbalize that they need to go potty and do so independently"
- Acknowledgement (Required)*
  
  I have read and understand the Summer Day Camp Information above.
- Parent/Guardian Signature*
- Fields marked with an asterick(*) are required.
- First Name:*
- Last Name:*
- Does your child have a nickname we should use?*
  
  YesNo
- Nickname if applicable
- Home Address Where Child Resides:*
- Who does child live with?*
  
  Both Parents (same household)Shared Custody (two households)Mother OnlyFather Only
- Do both parents have Custodial Rights?*
  
  YesNo
- Date of Birth*
  
  MonthDayYear
  Child must be 3 by 9/22/26 to attend.
- What is your child's current enrollment status with the Dearborn Early Learning Center?*
  
  Currently Enrolled at DELCPreviously attended DELCPreviously attended My Baby & Me ProgramHas never attended DELC or My Baby & Me
- What grade will your child be entering in Fall 2026?*
  
  PreschoolKindergartenFirst Grade2nd Grade3rd Grade
- What school or daycare center is your child currently enrolled at?*
- Room #1 - Attending Preschool this Fall - (Miss Lauren & Miss Jennifer)
  
  4 Day (M-TH) (9-3)2 Days (M/W) (9-3)2 Days (T/TH) (9-3)4 Days (M-TH) (8:30-11:30) (Only available for New Preschoolers)2 Days (M/W) (8:30-11:30) (Only available for New Preschoolers)2 Days (T/TH) (8:30-11:30) (Only available for New Preschoolers)
- Room #2 - Attending Kindergarten this Fall - (Miss Stacy & Miss Lynda)
  
  4 Day (M-TH) (9-3:15)2 Days (M/W) (9-3:15)2 Days (T/TH) (9-3:15)
- Room #3 - Attending 1st & 2nd Grade this Fall - (Miss Joelle)
  
  4 Day (M-TH) (9-3:30)2 Days (M/W) (9-3:30)2 Days (T/TH) (9-3:30)
- First Name:*
- Last Name:*
- Cell Phone Number:*
  Format: (000) 000-0000.
- Email Address:*
- Is Mother employed?*
  
  NoYes, Employed by an employerYes, Self-employed
- Occupation: *
- Employer/Business Name:*
- If not employed, what is Mother's current status?
  
  Stay-at-home-parentStudentUnemployed
- Include Mother in school texts and WHATSAPP Groups?*
  
  YesNo
- First Name:*
- Last Name:*
- Cell Phone Number:*
  Format: (000) 000-0000.
- Email Address:*
- Is Father employed?*
  
  NoYes, Employed by an employerYes, Self-employed
- Occupation: *
- Employer/Business Name: *
- If not employed, what is your current status?*
  
  Stay-at-home-parentStudentUnemployed
- Include Father in school texts and WHATSAPP Groups?*
  
  YesNo
- Has your child been diagnosed with any medical, developmental, behavioral, or emotional conditions that we should be aware of to ensure their safety and success?*
  
  YesNo
- Please check all that apply and provide details where requested.
  
  Speech/Language DelayHistory of Seizures with FeverEpilepsyAsthmaAutismOther diagnosed medical conditions
- If "Other" please explain:
- Does your child have any food allergies?*
  
  YesNo
- If Food Allergies is checked above, please list all food allergies:
  Examples: peanuts, tree nuts, eggs, sesame, milk, dairy, etc.
- What type of reaction does your child experience? (Please describe symptoms.)
  Examples: hives, vomiting, swelling, breathing difficulty, etc.
- Does your child require an Emergency Action Plan? (Epi-Pen, Inhaler, etc.)*
  
  YesNo
- Please check any emergency medications your child may require:
  
  Epi-PenBenadrylMotrinTylenolInhalerOther
- If "Other" please explain:
- Respect for adults and others starts at home. Families are responsible for supporting basic routines, boundaries, and readiness skills before enrollment.
  
  To be successful at DELC, preschoolers should be working toward:
  - Following adult directions and accepting the word NO from adults
  - Using kind words, gentle hands, and safe behavior
  - Participating in group routines, learning activities, and transitions
  - Communicating basic needs (help, bathroom, hurt, thirsty)
  - Separation readiness (comforted by teachers when needed)
  - Age-appropriate self-regulation with support
  All children are expected to already have these skills and be able to participate safely and successfully in a group setting with typical teacher support.
  
  If a child consistently requires ongoing one-to-one adult attention to participate safely and successfully, DELC may determine we are not the best placement and enrollment may be discontinued.
- Acknowledgement (Required)*
  
  I have read and understand the Behavioral Expectations of Children above and acknowledge that if my child requires ongoing one-to-one adult support to participate safely and successfully, DELC may determine that this is not the appropriate placement and enrollment may be discontinued.
- Parent/Guardian Signature*
- My child will be attending Summer Day Camp:*
  
  2 Full-Days Per Week (M/W or T/TH)4 Full-Days Per Week (M-TH)2 Half-Days Per Week (M/W or T/TH)4 Half-Days Per Week (M-TH)
- Full-Day Program
  
  2 Days (M/W)
  Payment #1 - Paid at Registration: $500.00
  Payment #2 - June 1, 2026: $500.00
  Total Cost: $1,000.00
  
  2 Days (T/TH)
  Payment 1 - Paid at Registration: $500.00
  Payment #2 - June 1, 2026: $500.00
  Total Cost: $1,000.00
  
  4 Days (M-TH)
  Payment #1 - Paid at Registration: $700.00
  Payment #2 - June 1, 2026: $650.00
  Payment #3 - July 1, 2026: $650.00
  Total Cost: $2,000.00
- Half-Day Program
  
  2 Days (M/W)
  Payment #1 - Paid at Registration: $500.00
  Total Cost: $500.00
  
  2 Days (T/TH)
  Payment #1 - Paid at Registration: $500.00
  Total Cost: $500.00
  
  4 Days (M-TH)
  Payment #1 - Paid at Registration: $500.00
  Payment #2 - June 1, 2026: $500.00
  Total Cost: $1,000.00
- REGISTRATION DEPOSIT PAYMENT (Due Upon Acceptance)
  
  A registration deposit is required to reserve your child’s spot. Once your child is placed in a class, you will receive a payment link via text (typically within 3–5 business days). To ensure your child’s placement is secured, payment must be made within 24 hours of receiving the link.
  
  ACH WITHDRAWAL
  
  There is not a fee for this service.
  
  CREDIT CARDS
  
  There is a $15.00 processing fee each time a transaction is processed.
- Acknowledgement*
  
  I have read and understand the Tuition Policy and Fees above.
- Parent/Guardian Signature*
- It is the responsibility of each parent to know what the policies and procedures are for the Dearborn Early Learning Center. These can be found in the Parent Handbook, Registration Packet and in Whatsapp Messages that will be sent after registering.
- Parent/Guardian Signature*
- I am aware that the facility’s licensing inspection and special investigation reports are available on the child care licensing website at www.michigan.gov/michildcare. Parents may also request to review our Licensing Notebook that contains licensing studies, inspections and renewal records, special investigations, corrective action plans, fire/safety/health compliance reports, etc. during regular business hours.
- Parent/Guardian Signature*
- I give permission for the Dearborn Early Learning Center to photograph and/or video record my child during classroom activities, school events, and regular school day routines. I understand that these images may be used on the school’s Instagram page, Facebook page, and official website for the purpose of sharing school activities and promoting the program
- Permission
  
  Yes, I give permissionNo, I do not give permission
- If permission is not given, your child will not be included in class group photos.
- Parent/Guardian Signature*
- State Licensing Requirement
  
  Under Michigan Child Care Licensing rules, children may be grouped in preschool classrooms based on age only with written parent permission when a child is under age 3 at the start of the school year.
  
  Because of your child’s age on the first day of school, state regulations require this written acknowledgement to ensure appropriate classroom placement and compliance with required child-to-staff ratios.
  
  This waiver is a standard licensing requirement and does not indicate a concern about your child. Please review and complete the section below so enrollment may proceed.
- By signing below, you are giving written permission for your child to be placed into a classroom with 3 & 4 year olds. During this time, the preschool ratio of 1:10 will apply, in accordance with Rule 400.8182 (4)
- Do you give permission for your child to be placed with 3 & 4 Year Olds?
  
  Yes, I give permissionNo, I do not give permission
- Parent/Guardian Signature*
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