Basic Information

Is there anyone in the family (parents and grandparents) who has now or ever had: 

At About what age did your child:

Where does the child receive emergency care?

Other responsible persons in case parent cannot be reached:

PLEASE NOTE: Anyone authorized to pick up a child will be asked for picture identification upon arrival, as well as sign in the Mindful Montessori visitor book.

If the parent or the person picking up the child will be later than 5:00pm for work related purposes, he / she must inform the reception desk by 4:00pm.

Authorized Person 1

Authorized Person 2

Authorized Person 3

Mindful Montessori may, at its absolute discretion, refuse to admit a child to the Mindful Montessori Early Learning Center, or require parents to withdraw a child from the Mindful Montessori Early Learning Center if, upon advice from medical and/or professional advisors, Mindful Montessori determines that so doing is in the best interests of the child.
Parent understands that Mindful Montessori reserves the right to refuse to permit Child to participate in the Program for no reason or any reason whatsoever, including, without limitation, the failure by Child to obey all warnings and instructions given to Child.

This Release and Indemnity by the undersigned, being the parent and/or legal guardian (hereinafter referred to as the "Releasor" or "Parent") of a minor child (hereinafter "Child"), is in favor of Releasees (as defined below).

RECITAL:

Parent has enrolled Child in the Mindful Montessori Early Learning Center (the "ELC"). The Mindful Montessori Early Learning Center conducts various activities and programs (collectively, the "Program"). Parent desires to permit Child to participate in the Program.

In consideration of Child being allowed to participate in the Program, the Releasor hereby agrees as follows:

1. Parent hereby expressly consents to Child participating in the Program. By permitting Child to participate in the Program, Parent fully acknowledges and understands that related activities involve risk of serious injury, including permanent disability and death, which risk may arise not only from Child's own actions, inactions or negligence but from actions, inactions or negligence of others and conditions that exist on the property upon which the Program will be conducted. Parent's decision to allow Child to participate in the Program is made in full recognition of these risks and is entirely voluntary. Parent hereby assumes all of the foregoing risks and accepts personal responsibility for any damages caused to Child therefrom.

2. Parent understands that Mindful Montessori reserves the right to refuse to permit Child to participate in the Program for no reason or any reason whatsoever, including, without limitation, the failure by Child to obey all warnings and instructions given to Child.

3. Parent has noted on the bottom of this form (in the comments section) any or all medical history or medical problems of Child. Parent has contacted Child's physician and has received medical permission for Child to participate in the Program.

4. Parent hereby releases, waives, discharges, covenants not to sue and indemnifies and agrees to hold harmless, Mindful Montessori LLP and its affiliates, including, Mindful Montessori Early Learning Center, and their respective officers, independent contractors, agents, representatives, counselors, and any employees or agents of any of the foregoing (collectively, the "Releasees"), from any and all liability to the Child, the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, death, or damage to property, caused or alleged to be caused in whole or part by Child's participation in the Program.

THE RELEASOR HAS READ AND FULLY UNDERSTANDS THIS RELEASE AND INDEMNITY. THE RELEASOR UNDERSTANDS THAT THIS IS A RELEASE OF ALL LIABILITY AND RESPONSIBILITY OF RELEASEES AND THAT RELEASEES HAVE RELIED ON THE RELEASOR'S STATEMENTS SET FORTH ABOVE.

Because the Mindful Montessori Early Learning Center is an innovative childcare facility, it mayattract interest both inside the company and in the press. Therefore, admin of Mindful Montessori Early Learning Center would like the parent's permission to include their child(ren) in any media coverage that is approved and screened by Mindful Montessori.

The parent gives permission to include his / her child.

The Mindful Montessori Early Learning Center recognizes the need, and is committed, to maintaining a safe, healthy, stimulating environment for children in our care and ensuring practices that minimize the spread of infectious diseases. Each Center will have a visiting health consultant work with the Center and parents regarding any health and medical concerns. All staff members are trained in CPR and First Aid. We regularly evaluate our policies and procedures in an effort to eliminate potential hazards and to improve the quality of care for the children. However, we will not be fully successful in this endeavor without the help of the parents. To maintain a healthy environment for all of the children at the Center, we cannot provide care for ill children. 

Parents will be provided with a copy of the Center’s health policy as well as a copy of information from the State Department of Health when they enroll in the Mindful Montessori Early Learning Center. Parents are required to complete a health questionnaire, which requests information about their child’s sensitivities or allergies, reoccurring illnesses and medication history. We expect parents to regularly update this information. Parents are also required to provide the Center with documented evidence of the child’s immunization status. Please bring in documentation from your doctor to keep our records up-to-date whenever your child receives a new immunization. Every child is required to have a hearing and vision screen by a qualified health care provider upon turning the age of 4 years and before 5 years of age. The results shall be documented on our physician’s form, signed and dated by the health care provider, and returned to the manager for the child’s file. We are required to maintain this information. 

Each child entering the Center must have a physical exam. The results of the physical must be submitted to the Center prior to the child’s first day of phase-in. To maintain enrollment, children in all Centers must have a physical exam every 12 months, with the results of these exams filed with the Center by the due date. 
In the event of an outbreak in the school of a vaccine-preventable disease (e.g. whooping cough, measles) children who have not been vaccinated for that disease will, as required by the Department of Health, be excluded from attending the school until the risk has passed. 

Children who have any infectious illness will not be permitted access to the Center until the risk of infection to other children has passed. A doctor’s note is required before the child will be permitted to return to his/her class indicating they are free of contagion. 

Parents must notify the school on the first day of the child’s absence and must supply, on the child’s return, a note detailing the reason for the absence as well as any other information pertaining to the illness. This information will be filed with the child’s records. 

Should a child become ill during the course of the day or arrive ill, compromising their ability to participate in the daily activities, the parents or emergency contact will be notified and are required to take the child home. In the meantime, the child may rest on a cot in the classroom or office. Staff members will check on the sick child regularly to monitor the child’s temperature/condition and to make sure the child is comfortable. 

Regular attendance is important for the child. However, there is no advantage in sending a sick child to school. A child may be too ill to participate in activities even without symptoms. A child who is not well requires additional attention from the staff, which creates a burden and promotes infection between staff and children.

Lead Screening

Exposure to Lead 
A blood test will identify if your child has elevated levels on lead. It is recommended that all children have a lead screen during the child’s annual health exam. Lead exposure can occur from the following sources:

1. Living in a home built prior to 1978.
2. Having done any home renovations including replacement of windows and removal of paint since your child was born.
3. Living in a neighborhood where other children have elevated levels of lead.

Mindful Montessori Early Learning Centers self-report that there are no lead products on site. We take extra measures to ensure from our vendors that our children’s furniture, toys and materials are lead free. 

Lead Exposure can cause the following ailments: 

1. Breathing difficulties
2. Seizures
3. Behavior problems
4. Loss of appetite
5. Developmental delays
6. Brain damage
7. Blood disorders

If you feel your child may have been exposed to lead you can contact your local health agency for more information on how to proceed with care and removal of lead in your environment. To comply with the EHCC, the Mindful Montessori Early Learning Centers are a lead free environment. All buildings were built after 1978. All water provided to children is cold (drinking and cooking). All taps are run for 5 – 10 seconds before used for beverages or cooking. 
In keeping the Center healthy, all staff must submit their immunizations* and health reports upon employment, as well as a current TB exam. Staff members are required to re-submit TB exam results and physical results every two years. 

Exclusion Due to Illness

Should a child become ill during the course of the day or arrive too ill to participate in the daily activities, the Center Management and Staff will collaborate and make the best decision whether or not to send the child home. The parents or emergency contact will then be notified and are required to take the child home. In the meantime, the child may rest on a cot in the classroom or office. Staff members will check on the sick child regularly to monitor the child’s temperature/condition and to make sure the child is comfortable. All confirmed communicable illnesses are required to be communicated with all parents of the Center. Please refer to the communication policy regarding communication of illnesses to parents.

We will ask parents to keep their child home or to remove the child from the Center under the following circumstances:

1. A temperature over 100 degrees.
2. A child must be free of fever without the aid of medication for at least 24 hours prior to attending or returning to the Center.
3. If the child is in pain or has cold symptoms (including a cloudy discharge from the nose) which prevents participation in the program, inside or out. (For example, if the child is medicated to the extent that he/she falls asleep or is extremely irritable).
4. If the child has been vomiting and/or has had diarrhea within the past 24 hours. Children will not be permitted in the Center until they have been free from symptoms for 24 hours.
5. If the child has strep throat, he/she must be on medication for at least 24 hours before returning to school.
6. If the child has a rash, parents must produce a doctor's note stating the child's diagnosis and that the condition is not contagious.
7. If the child has pinkeye he/she must be on medication for at least 24 hours before returning to the Center.
   • After that time, the child cannot return if there is still discharge coming from the eye. When the child does return, a doctor's note is required stating that he/she is no longer contagious.
8. If the child has a contagious condition, such as impetigo, a doctor's note is required stating that he/she has undergone full treatment, is no longer contagious, and may return to the Center. This is necessary to protect both the child and other children that attend the Center.
9. Open wounds, such as bleeding diaper rashes must have a Doctor’s note for child to remain in Center as well as to receive ointment.
10. If the child has any type of communicable illness, he/she will not be permitted in the Center for the period of time specified by the Department of Health for such a condition or until the symptoms clear, whichever is later.
11. Parents will inform the Center within 24 hours after their child or another member of the household has developed a reportable communicable disease. This includes but is not limited to Tuberculosis, Smallpox, Chicken Pox, Hepatitis, Lyme Disease.
12. If the child has pediculosis (head lice), please bring in the box top or label of the specific shampoo used to treat the condition.
    • The child's hair must be completely free of any nits before he/she is allowed to return.
    • A manager must check the child before returning to the Center.
    • Additionally, Montessori Children’s Center staff must check the child before he/she will be permitted to return to class.

Should a child suffer a chronic condition (e.g. asthma), symptoms related to this condition should be discussed with the child’s teacher and management, including the doctor’s case plan for the condition.

We need your cooperation in keeping ill children home to help us maintain a better environment for all of your children and to try to stop the spread of illness.

Thanks!

Medication Policy*

Parents are expected to administer ALL medication to their children. The first dose of medication must be administered at home. We encourage parents to schedule medication times around their child’s attendance at the school. It is the responsibility of the parent to come to the Center and administer the medication at the appropriate times if medication must be dispensed during the day. The following procedures apply to children who require medication, including over the counter medication, during the day:

1. Parents must inform teachers if their child is taking medication and any possible side effects.
2. The parent must fill out state appropriate medication form. This form will be kept in the child’s file.
3. Medication cannot be administered by putting it in your child’s bottles or food.
4. The medication must come in its original container. Each Center must comply with state mandates in regards to storage of medication. Any medication requiring refrigeration that cannot be stored with the child’s guardian must be stored in an assigned refrigerator that children cannot access. The refrigerator must have a thermometer and be kept between 38 and 42 degrees.
5. Appropriate State documentation giving the Center permission to administer emergency medication will be completed by the doctor and parents and be kept on file in the Center. The educator must not administer any medication contrary to the directions on the original container, unless so authorized in writing by the child’s licensed health care practitioner. Any medications without clear instructions on the container must be administered in accordance with a written physician or pharmacist’s descriptive order.
6. The Center supervisors and selected trained staff can administer medication in emergency situations when appropriate documentation and training has been provided. Emergency medication includes medication used to treat seizures, an allergic reaction or other medically noted issue. Emergency medication is the only medication that can be stored in the Center. The medication is stored in a locked cabinet or drawer. The medication is clearly labeled for the individual child who is to receive the medication. The Center does not provide any medication of any kind for any ailment or illness. Parents must provide all medication in original containers. If medications expire while being held in the program the medications will be returned to the parents.
7. Supervisors and selected staff will receive appropriate training on how to administer medication and will have the appropriate documentation regarding this training on file in the Center following all state licensing requirements.

Emergency medications must be immediately available. Epi pens and other emergency medications must be kept unlocked and travel with students outdoors. A Medication Log will be kept. Staff must supervise parents administering medication and that compliance to the five rights is met. Parent and staff member must sign and date the log. Log is kept in the center office. 

The Parents have read and understand the Illness Policy , the Exclusion Due To Illness Policy, and the Medication Policy set forth by the Mindful Montessori Early Learning Center.