Compass Early Learning Enrollment Application

Parent/Guardian Information
Parent 1 Email*
Medical documentation will be sent to this email address.
Parent 1 Information*

Name

Workplace

Work PhoneCell Phone
Parent 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Same address as child's

Yes
Parent 2 Email
example@example.com
Parent 2 Information

Name

Workplace

Work PhoneCell Phone
Parent 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Same address as child's

Yes
Additional Instructions on reaching parents:*
Who should we contact first?

Emergency Contacts
For the protection of your child, please list below the names and phone number of those persons you authorize to pick up your child from Compass. Emergency contacts must be friends or other family members who do not live with you and are familiar with your child. Compass will only release your child to adults you designate as authorized. It is our policy to ask all unfamiliar adults for photo identification. Please notify the Teacher and Director if someone other than the primary or secondary parent/guardian will be picking up your child on a given day. If they are not listed and/or they do not have identification your child will not be released. You may adjust this list at any time.
Emergency Contact 1*

Full Name

Address

CityPhone

Relationship to Child
Emergency Contact 2*

Full Name

Address

CityPhone

Relationship to Child
Authorized to Pick Up

Same as Emergency Contacts
Authorized to Pick Up 1

Full Name

Address

CityPhone

Relationship to Child
Authorized to Pick Up 2

Full Name

Address

CityPhone

Relationship to Child
In the event that a parent or emergency contact cannot be reached during a minor emergency, Compass will contact 911 and follow the instructions given by emergency personnel. Compass will continue to attempt to contact parents & emergency contacts, until they are reached. In the case of a major emergency 911 will be contacted immediately by 1 staff while a additional staff contacts the parents. By signing below you are stating that you agree to this policy.
Name

First NameLast Name
Signature

Clear

Medical Information
Primary Care Doctor*

Doctor's Name/Clinic

Address

PhonePhone Number
Insurance Company*

Name

Policy Number

PhoneGroup Number

Postal / Zip Code
Known Allergies
Medical Needs
Ongoing Medications
Yes, I am including with this application:

Immunization RecordsHealth Care Summary
Dentist*

Dentist's Name/Clinic

Address

PhonePhone Number
Dental Insurance same as Medical Insurance?

Yes
Dental Insurance

Name

Policy Number

PhoneGroup Number

Postal / Zip Code
Does your child have ongoing medical issues?
If yes, describe.
Is your child taking medications?
If yes, describe.
Any additional medical things we should be aware of?
If yes, describe.

More about your Child
Height
Weight
Hair Color
Eye Color
Distinguishing Marks
Is your child

Right handedLeft handedUnknownBoth
List Child’s Group Care Experience
Describe your child’s favorite types of toys and activities
Tips for comforting your child
Describe your child’s normal temperament
Happy, quiet, shy, active?
List any behavioral issues your child may have
List anything that your child might fear
Puppets, vacuum cleaner, etc.
List anything else we should know that will help your child have an easy transition into our care:

Home Culture
Primary Language spoken at home:
Holidays Celebrated
Cultures or traditions most important to child's identity:

Tuition Agreement
Tuition is due the Thursday before the week the services are provided. Late fee of $25 will be assessed on Friday at noon. If there are 2 weeks with no payment, enrollment will be terminated. Tuition owed will still be due and will be pursued. Tuition is due even if days are missed or in-case of holidays. Part time schedules are set, and based on availability, Sibling discount is 10% off the oldest child. Rates are subject to change, and reevaluated each January.
Initial here.
Additional Fees: Application fee is $100/child. Due with enrollment agreement. This fee is Non-Refundable. Field Trips are additional and optional. The cost varies. If your child does not go on the field trip they will join a class that is not attending the field trip and may not be within his/her age group. (i.e. a preschooler may spend the day in the toddler room)
Initial here.
Vacation Policy: We offer vacation benefits to all families who have been enrolled for at least 6 months. Account must be in good standing at time of vacation. You will be granted 2 weeks to be used in 1 week increments. The Director must be notified of said vacation 2 weeks prior. For these 2 weeks your child is not at the center, you will not be required to pay tuition. All other times your child is absent (due to illness, holiday, weather) your full tuition will be due. These vacation days may not be broken up, they must be used in a full Monday-Friday increment.
Initial here.
Holidays: We are closed: New Year’s Day, President’s Day, Good Friday, Memorial Day, 4th of July, Friday before Labor Day & Labor Day, Thanks-giving, Friday after Thanksgiving, Christmas Eve & Christmas Day. If holiday falls on a Saturday, the center will be closed on Friday. If holiday falls on a Sunday the center will be closed on Monday.
Initial here.
Weather: We will follow the Anoka-Hennepin School District 11 for Snow related school closings, cold weather closings will be at Compass management discretion.
Initial here.
Staff Recruitment: We know our staff is great! That’s why we have invested so much time and finances in interviewing, screening, training and development. With this in mind, any family that recruits a member of our staff to work for them as private child care will be assessed a $2,000 fee. Staff are under a non-compete for a year after employment termination. Staff who leave to work for a family enrolled (or formerly enrolled) will also be assessed a $2,000 fee. Outside of work hours babysitting is acceptable and negotiated directly between staff and parents.
Initial here.
Notice: If you wish to remove your child from our program, a written 2 week notice is required. If you choose to remove your child before 2 weeks have passed you will still be required to pay tuition for those 2 weeks.
Initial here.
Late Pick Up: We are licensed to operate until 6:00 p.m. If you arrive after hours, you will be required to pay the staff directly $5 for every 5 min. you are late. Our staff clock out at 6:00 p.m. so you are hiring them as private babysitters after that time.
Initial here.
Parent/Teacher Conferences: We offer parent/teacher conferences 2 times a year. Parents will receive an assessment of skills for their child at this time.
Initial here.
Transportation: If you have registered your child for a field trip you are also authorizing Compass to transport your child to and from said field trip. I understand that all licensing guidelines will be followed.
Initial here.
Walking Field Trips/Walks: You are authorizing Compass to take your child on walks. All walks will be supervised (above) licensing guidelines and will be for educational purposes.
Initial here.
Photos: You are authorizing Compass to take pictures of your child during classroom activities and field trips. This will be used in-house to document the fun for parents. This includes annual class photos.
Initial here.
Marketing: Some of the photos we take will be used on social media and for marketing purposes. You have the right to refuse the use of your child’s photos.

Yes, I am okay with you using photos of my child’s face.No, I prefer you don’t use photos of their face.
Nurse and Public Health: We have a monthly visit from a public health nurse. This nurse has complete access to child files.
Initial here.
Parent Policies Handbook
Parent Policies Handbook: You are acknowledging that you received the Parent Policies Handbook and you have read them and are agreeing to the policies outlined in the handbook.
Initial here.
MN State DHS Licensing Guidelines
MN State DHS Licensing Guidelines: We are bound to the guidelines laid out by the DHS . If you would like to see these guidelines there is a copy in the office for your review.
Initial here.
I have read and agree to the Parent Policies list on this page and laid out in the Parent Policies Handbook.

Yes
Signature

Clear
Should be Empty:

Child Information

Parent/Guardian Information

Emergency Contacts

Medical Information

More about your Child

Daily Schedule

Home Culture

Tuition Agreement