JC Sunshine Childcare Enrollment & Time Selection Form

JC Sunshine Childcare Enrollment Packet

Please complete all required sections to enroll your child at JC Sunshine Childcare. Have relevant documents ready for upload.
Child Information
Child Legal Name

First NameMiddle NameLast Name
Preferred Name / Nickname
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sex / Gender

Other
Language(s) Spoken

Other
Additional Child Identity Details
Enrollment and Schedule Requested
Requested Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Care Type Requested
Schedule Notes and Enrollment Preferences
Parent/Guardian 1
Parent/Guardian 1 Full Name

First NameMiddle NameLast Name
Relationship to Child
Address is different from child's address
Parent/Guardian 1 Address (if different)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Parent/Guardian 2 (optional)
Optional section
Parent/Guardian 2 full name

First NameMiddle NameLast Name
Relationship to child
Address if different

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone number(s)
Please enter a valid phone number.Format: (000) 000-0000.
Email address
example@example.com
Home Address
Street Address
Apartment / Unit
City
State
ZIP Code
Emergency Contacts
Emergency Contact 1
Emergency Contact 2
Emergency Contact 3
Emergency Contact Availability Confirmation
Authorized Pick-Up List
Authorized Pick-Up Person(s)
Authorized Pick-Up Person(s)
Authorized Pick-Up Person(s)
Release Authorization Notes
Verification Method(s) Required

Other
Additional Pick-Up Instructions
Acknowledgment of Pick-Up Authorization List
People Not Authorized to Pick Up and Custody Notes
People Not Authorized to Pick Up
Custody or Court Order Notes
Release Restrictions and Safety Instructions
Custody Documentation Reference
Child Health and Medical Information
Known Medical Conditions

Other
Describe Medical Conditions
Medications Taken at Home
Medications to Be Given at Daycare
Chronic Conditions or Ongoing Health Concerns
Health Restrictions or Activity Limitations
Physical/Medical Statement Attached
Allergies and Special Diet
Food Allergies

Other
Environmental Allergies

Other
Describe Allergy Reactions
Severity of Allergies
Special Dietary Needs and Emergency Response Instructions
Doctor, Dentist, and Insurance Information
Doctor Name

First NameLast Name
Clinic Name
Doctor Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Dentist Name

First NameLast Name
Dentist Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Health Insurance Provider
Policy / ID Number and Coverage Notes
Developmental and Individual Needs
Does the child have an IEP or IFSP?
Which developmental, disability, or special needs apply?

Other
Please describe the child's developmental, disability, or special needs
Communication needs and preferred communication methods
Calming strategies and comfort supports
Toileting needs or assistance required
Feeding, nap, or sleep needs
Behavior, supervision, or safety concerns we should know about
Uploads
Immunization Record

Cancelof
Physical / Medical Statement

Cancelof
ACS / Voucher Paperwork

Cancelof
Insurance Card/Custody / Court Documents

Cancelof
IEP / IFSP Documents

Cancelof
Permissions and Consents
Emergency medical care and 911 authorization

Other
Outdoor play permission

Other
Neighborhood walks permission

Other
Photo/video permission for parent app

Other
Photo/video permission for classroom use

Other
Photo/video permission for social media and website

Other
Note
Tuition and Attendance Agreement
Tuition and Attendance Agreement
Late Pick-Up Policy: JC Sunshine Childcare closes at 6:00 PM. Late pick-up fees apply after closing. Repeated late pick-ups may lead to a parent meeting or termination of care.
I have read and understand the Late Pick-Up Policy.
Early Drop-Off Policy: Children may only be dropped off at their approved scheduled time. Early drop-off must be approved in advance and may require an early care fee or add-on.
I have read and understand the Early Drop-Off Policy.
Nonpayment Policy: Tuition and parent balances are due as agreed. Payment is required to hold the child’s spot. Unpaid balances may result in late fees, pause of care, a required payment plan, or termination of care.
I have read and understand the Nonpayment Policy.
Termination of Care Policy: Care may be terminated for ongoing nonpayment, repeated late-pick-ups, unsafe behavior that cannot be safely supported, failure to follow program policies, or missing required paperwork. Notice will be given when possible, but immediate termination may happen for serious safety or payment concerns.
I have read and understand the Termination of Care Policy.
Sick Policy: Children must stay home for fever, vomiting, diarrhea, contagious illness, untreated lice, unexplained rash, or symptoms that prevent participation. A child may return when fever-free without medication and symptoms have improved, or with doctor clearance when needed. Parents must pick up a sick child promptly when contacted.
I have read and understand the Sick Policy.
Acknowledge Tuition and Attendance Terms

Other
Agreed Weekly Tuition Amount
Agreement Comments
I understand that this enrollment packet does not replace any required OCFS forms, medical statements, immunization records, medication consent forms, or other documentation requested by JC Sunshine Childcare or NYS OCFS.
Parent/Guardian Acceptance
Daycare Time Selection Agreement Form

Enter your details, choose the day(s) and one care time slot, then review the out-of-slot fee notice and sign with dates.
Parent Full Name

First NameLast Name
Child Full Name

First NameLast Name
Child's date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Do you have multiple children enroll in the daycare? If you do a separate form must be done for them. They both must come in at the same time and picked up together.
Select the day(s) of the week your child will be in care
Monday care time slot
Tuesday care time slot
Wednesday care time slot
Thursday care time slot
Friday care time slot
Parents understand that care is only for 10 hours a day. Anything extra is $15 an hour. Late fees are $2 per min after their set time slot in the daycare.
Parent Signature
Date (Parent Signature)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

JC Sunshine Childcare Enrollment Packet

Child Information

Enrollment and Schedule Requested

Parent/Guardian 1

Parent/Guardian 2 (optional)

Home Address

Emergency Contacts

Authorized Pick-Up List

People Not Authorized to Pick Up and Custody Notes

Child Health and Medical Information

Allergies and Special Diet

Doctor, Dentist, and Insurance Information

Developmental and Individual Needs

Uploads

Permissions and Consents

Tuition and Attendance Agreement

Daycare Time Selection Agreement Form