Discover Our World Academy Registration Form

Discover Our World Academy Registration Form
Date*

MonthDayYear
Child's full name*

First NameLast Name
Child's age*
Child's Birthday*

MonthDayYear
Date
Nickname*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Info:
Mom's name*
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's name*
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Person #1*
Contact's phone*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Person #2*
Contact's phone*
Please enter a valid phone number.Format: (000) 000-0000.
Please provide the names and Phone numbers of at least 3 people who are allowed to pick up your child. (Please note if their names are not on this list they will not be release to anyone else). And they must show ID.
Name*

First NameLast Name
Relation to the child*
Phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*

First NameLast Name
Relation to the child*
Phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Name *

First NameLast Name
Relation to the child*
Phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Service Information:
Beginning date needing care*
Hours:
Monday*
Tuesday*
Wednesday*
Thursday*
Friday*
Your Child's Health
Medical information:
Insurance provider:*
Group Number*
Member ID number*
CHILD'S HEALTH RECORD: (A copy of your child's immunizations and current physical will be needed)*

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We will need a copy of the child's health insurance card for our files*

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General state of health:
Doctor's name*

First NameLast Name
Doctor's phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Dentists' name*
Dentists' phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Are your child's immunizations up to date?*
Please attach a copy of immunizations. This should include the signature of nurse or doctor who administered medications.)*

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Does your child have any known allergies?*
Does your child have any medical conditions which we should be made aware of?*
Has your child had the following common childhood illnesses? (Please circle)
ConstipationConvulsionsDiarrheaFainting SpellsFrequent ColdsFrequent Ear InfectionsFrequent Sore Throats LiceRingwormSkin RashSoilingStomach UpsetsUrinary Problem Worms
AsthmaBronchitisChicken PoxDiabetesHeart DiseaseHepatitisImpetigoMeaslesMumpsGerman MeaslesPolioScarlet FeverTuberculosisWhooping Cough
YesNo
Would there be any restrictions to play or activities?*
About Your Child
Has your child ever been in child care before?*
What type (center, family daycare, grandma etc?)*
How does your child feel about daycare and being left by his/her mommy/daddy?*
Are there any recent traumatic situations the child has been exposed to such as a death in the family, divorce, new sibling etc.?*
Are there any food restrictions or food allergies?*
What is your child's favorite food?*
What foods does your child dislike?*
YesNo

Are there any siblings? Please name them and specify ages and gender.*

Rows	Name	age	gender
1
2
3
4

Are there any other comments or information you would like us to be aware of?*
Do you have any specific concerns?*
Signature

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Date

MonthDayYear
Date
Park Permission

Discover Our World Academy
I * give permission for my child attend daily park trips when the weather permits.
Parent's Name*
Parent's Signature*

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We will attend Bala Avenue Park located 33 Bala Avenue, Bala Cynwyd, PA 19004. All children will be accompanied by 2-3 Teachers.
Parental Consent Form For Photos
I * the parent of * Give permission for Discover Our World Academy to video tape or take photos of my child for promotional purposes. I understand that the video and or pictures can be used on social media, commercials, advertising ads, websites or any other marketing materials.
PRINT PARENTS NAME*
PRINT CHILDS NAME*
SIGN NAME*

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DATE*

MonthDayYear
Date
Discover Our World Academy Permission for Neighborhood walks
Child's name*

First NameLast Name
At Discover Our World Academy we will have neighborhood walks for the children to get some fresh air and expiore the neighborhood. We will teach on our waiks about the seasons, the weather, colors, animals and other natural environmental habitats. All walks are supervised with teachers and aides to ensure the safety of your children. Please sign this consent if you give permission for your child to participate.
Yes my child can participateNo my child cannot participate
Parents signature*

Clear
Date*

MonthDayYear
Date
Discover Our World Academy emergency transportation consent
I * the parent of * read and understand that in the event of a medical emergency I give permission for my child to be sent to the nearest hospital for treatment via ambulance. I also understand that I will be contacted immediately and that a lead teacher or director will remain with my child until I arrive.
Parent*
Director*
Signature*

Clear
Date*

MonthDayYear
Date
Discover Our World Academy Sick Policy

Tuition is still due when your child is out sick
When a child may not attend school:
- Fever: Children will be sent home if their temperature is 100.0 or higher and must stay home the next day for observation. Children must be free of ſever (any temperature above 98.6 degrees) for at least 24 hours without the use of fever reducing medication. The same policy applies if your child develops a fever at home. They must be fever free (any lemperature above 98.6 degrees) for at least 24 hours without the use of fever reducing medication.
- Rash: Any rash other than a common diaper rash or skin irritation will require that child to be sent home for an evaluation and diagnosis from thcir doctor in writing of exactly what it is. They may return to school based on that written doctor's evaluation, and clearance that it is not contagious.
- Conjunctivitis (pink ceye): Children will be sent home if there appears to be an unusual amount of discharge from or irritation to their eye(s) and must stay home the next day for observation. Before returning to school they will need an evaluation and diagnosis from their doctor in writing of exactly what it is. If the diagnosis is BACTERIAL CONJUNCTIVITIS children must have received at least 24 hours of treatment. If the diagnosis is VIRAL CONJUNCTIVITIS your child may return AS LONG AS THERE IS NO DISCHARGE. If in fact they do not have "pink eye" we need a doctor's note with a diagnosis and a clearance that it is not contagious.
- Thick White, Green or Yellow Discharge: Children will be sent home if they appear to have any thick white, green or yellow discharge. This is often indicative of an infection and they must stay home the next day for observation. Before returning to school they will need an evaluation and diagnosis from their doctor in writing and at least 24 hours of treatment, If in fact they do not have an infection we need a doctor's note with a diagnosis of exactly what it is with a clcearance that it is nothing contagious. The Department of Health and most doctors are of the opinion that once on antibiotics for 24 hours, the discharge is no longer contagious even though it may persist for up to two weeks.
- Diarrhea: Children will be sent home if they have three or more loose bowel movements in one day and must stay home the next day for observation. Before returning to school (after the day of observation) children must be free from diarrhea for 24 hours with at least 1 regular bowel movement. If your child has one or more loose bowel movements on their first day back they will again be sent home.
- Vomiting: Children will be sent home if they vomit and must stay home the next day for observation, before at least returning 24 hours to school (after the day of observation) children must symptom free with no vomiting
- Persistent Hacking Cough: Children will be sent home if they have a persistent hacking cough and home the next day for observation. Before returning to school they will need an diagnosis from their doctor in writing and at least 24 hours of treatment. If in fact they do not require any treatment we need a doctor's note with a diagnosis of exactly what it is with a clearance that it is not contagious.
Childs Name*
Parents Signature*

Clear
Should be Empty:

Discover Our World Academy Registration Form

Contact Info:

Service Information:

Your Child's Health

Medical information:

General state of health:

About Your Child

Park Permission

Parental Consent Form For Photos

Discover Our World Academy Permission for Neighborhood walks

Discover Our World Academy emergency transportation consent

Discover Our World Academy Sick Policy