EARLY CHILDHOOD EDUCATION CENTER ENROLLMENT FORM

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "EARLY CHILDHOOD EDUCATION CENTER ENROLLMENT FORM"

Transcription

1 EARLY CHILDHOOD EDUCATION CENTER ENROLLMENT FORM 55 PA CODE CHAPTERS & 181 (C): & 181 (C): & 181 (C) CHILD S FIRST NAME MIDDLE NAME LAST NAME BIRTH DATE START DATE WITHDRAWAL DATE PLANNED DAILY ARRIVAL TIME PLANNED DAILY PICKUP TIME TUITION FEE (for service from 7:00AM - 5:30PM) INFANT TUITION $230 (6-12 mo.) OLDER TODDLER TUITION $220 (25-47 mo.) YOUNG TODDLER TUITION $225 (13-24 mo.) PRE-KINDERGARTEN WEEKLY $215 (48 mo. to date child enters Kindergarten) PAYMENT SCHEDULE (choose one) WEEKLY BI-WEEKLY TYPE OF ACCOUNT (money orders are the method of payment accepted) PRIVATE PAY CCIS PAYMENT, FEES, & CHARGES I understand the services to be provided as part of the day care fee are for educational instruction, developmentally appropriate care, meals for children, special events, laundering sheets and blankets. I agree to pay weekly every Friday before 12pm by putting the payment inside the drop box located inside the center by the front door. I understand one week of unpaid overdue of unfulfilled results in an immediate termination of service. I agree to pay the full tuition fee even if my child is absent for one or more days. Tuition is not subject to discounts for holidays, professional development training, emergency closures (i.e. weather), sick days or doctor appointments. I agree to pay a late pickup fee of $25 (per child) when tuition is not received on time by Friday before 12pm. I understand the late fee charge will be waived if the center is notified of child s absence in advance and the payment is paid in full on the day of the child s return. I agree to pay a late pickup fee for every 10 minute, per child, if my child is not picked up before closing ($25 for first 10 minutes and $10 for each 10 minutes thereafter). I agree to pay weekly the difference when CCIS subsidy does not covered the full amount of weekly tuition. As a CCIS recipient, I agree to pay the provider the daily rate when my child exceeds the allotted 25 days of absence. I agree to pay the weekly tuition rate when I am ineligible for CCIS or suspended. I agree to update the Emergency Contact/Parental Consent Form information whenever changes occur or every 6 months at a minimum ( , , ). I understand vacation time is available for families in accordance with the center s vacation policy. I understand the child may have the opportunity to participate in a special program or field trip that may have an additional fee due before the day of the event. A specific permission slip may be required. MEDICAL POLICIES & PROCEDURES Prior to enrollment, I will provide the center with updated medical and immunization information for my child. This informationis to be kept current and updated in accordance with state child care regulations. I agree to provide information to the child center about my child s conditions, illnesses, allergies or other needs. If my child becomes ill with a reportable contagious disease, I understand that he/she will not be able to return until I bring in a physician s note stating that he/she is no longer contagious. If my child becomes ill during his/her time at the child care center, the staff will contact me to pick up my child. I will arrange a pickup no later than 2 hours after being contacted. If I cannot be reached, the staff will contact those individuals listed in the Emergency Contact and Release. A child may come to school from a doctor s appointment if they have a doctor s notes and arrive by 11:00am. FORM OF PAGE 1

2 EARLY CHILDHOOD EDUCATION CENTER ENROLLMENT FORM 55 PA CODE CHAPTERS & 181 (C): & 181 (C): & 181 (C) OPERATING HOURS POLICIES & PROCEDURES Regular operating hours are Monday through Friday from 7AM - 5:30PM. The dropoff/arrival time is between 7AM - 9AM. Any dropoff or arrivals after 9AM must be communicated to the ECEC office supervisors at This policy is in place to minimize disruptions in the classroom and to support classroom instruction time. Meals are served during the following times: Breakfast, 7:30AM - 9AM; Lunch, 11AM - 12:30PM; Snack 2:30PM - 3PM. Bringing food from home is not permitted in the facility/classroom with the exception of infant food/formula. Please acknowledge the following days when the center is closed or operating with modified hours due to holidays and professional development days (There is no reduction in tuition as a result of these center closures or any emergency closure): INDEPENDENCE DAY CLOSED LABOR DAY CLOSED THANKSGIVING DAY CLOSED DAY AFTER THANKSGIVING CLOSED CHRISTMAS EVE / OPEN 7AM - 2PM CHRISTMAS DAY CLOSED NEW YEARS EVE / OPEN 7AM - 2PM NEW YEARS DAY CLOSED MONDAY AFTER EASTER CLOSED MEMORIAL DAY CLOSED PROFESSIONAL DEVELOPMENT DAYS (TBD - 5 additional days may be required) ELECTRONIC DATA, DEVELOPMENTAL SCREENING & ASSESSMENTS In Pennsylvania, the Office of Child Development and Early Learning provides funding to a variety of statewide early education programs which are PA Keys STARS Child Care Centers such as ours. Electronic data systems are needed to maintain individual child records and to collect data for improving early childhood porgrams. I understand and give consent to complete a developmental screening, assess, maintain individual child records and collect data about my child. FAMILY HANDBOOK ACKNOWLEDGEMENT I received complete written program information at the time of enrollment ( , , ). I understand and agree that it is my responsibilty to read and familiarize myself with policies and procedures outlined in the Family Handbook and agree to abide by them. I understand that it is my responsibility to go directly to management with any questions I may have regarding the policies and procedures and information contained in this Enrollment Agreement. Information contained in the Family Handbook may be subject to change. TO BE SIGNED ON-SITE / IN PERSON CONTRACT APPROVAL I certify that I have read, understand and accept all of the terms and conditions described in this Enrollment Agreement. PARENT S NAME DATE PERIODIC REVIEW To be completed every 6 months PARENT S NAME DATE FORM OF PAGE 2

3 EARLY CHILDHOOD EDUCATION CENTER PARENTAL CONSENT FORM Completion of this agreement is required for enrollment. This form will enable us to better understand your child and meet his/her needs. Much of the information requested is necessary to comply with state child care licensing regulations. CHILD ENROLLMENT INFORMATION FIRST NAME MIDDLE NAME LAST NAME HOME ADDRESS STATE ZIP NICKNAME BIRTH DATE ADMISSION DATE SEX EYE COLOR HAIR COLOR MOTHER S NAME/LEGAL GUARDIAN PARENT/GUARDIAN/SPONSOR HOME ADDRESS (if different than child s) STATE ZIP HOME HOME PHONE WORK EMPLOYER EMPLOYER ADDRESS CELL PHONE WORK PHONE STATE ZIP WORK HOURS FATHER S NAME/LEGAL GUARDIAN PARENT/GUARDIAN/SPONSOR HOME ADDRESS (if different than child s) STATE ZIP HOME HOME PHONE WORK EMPLOYER EMPLOYER ADDRESS CELL PHONE WORK PHONE STATE ZIP WORK HOURS Are there any visitation restrictions you wish to notify us of? YES NO MEDICAL INFORMATION PRIMARY PHYSICIAN S NAME PRACTICE NAME PHONE PRACTICE ADDRESS STATE ZIP CHILD S HEALTH INSURANCE PROVIDER POLICY # SECONDARY HEALTH INSURANCE PROVIDER POLICY # FORM OF PAGE 3

4 EARLY CHILDHOOD EDUCATION CENTER PARENTAL CONSENT FORM Completion of this agreement is required for enrollment. This form will enable us to better understand your child and meet his/her needs. Much of the information requested is necessary to comply with state child care licensing regulations. EMERGENCY CONTACT PERSONS & RELEASE INFORMATION (do not include parents/guardians/sponsors) As the parent/guardian/sponsor, I authorize The Salvation Army to release my child(ren) to the person(s) designated below. This is in consonance with The Salvation Army Emergency Plan & Release Policy and Procedure. I understand the staff will only release my child to those persons listed below. If I want a person who is not identified below to pick up my child, I must notify the office supervisors in advance at My child will not be released without prior authorization and proper identification. I will notify the center if an Emergency Release Contact will pick up my child on a given day or understand it is my responsibility to maintain current contact information. CONTACT #1 HOME ADDRESS STATE ZIP CONTACT #2 HOME ADDRESS STATE ZIP CONTACT #3 HOME ADDRESS STATE ZIP AUTHORIZATION CHECKLIST (Parent s initial is required for each item below to indicate parental consent) OBTAINING EMERGENCY MEDICAL CARE ADMINISTER MINOR FIRST AID PROCEDURE WALKS & TRIPS SWIMMING TRANSPORTATION BY THE FACILITY WADING PHOTO CONSENT AGES & STAGES SCREENING FORM OF PAGE 4

5 MEDICAL, DEVELOPMENTAL HISTORY & SPECIAL NEEDS Please attach a copy of your child s most recent physical as well as any instructions or specific information from your physician that will help us better care for you child. DOES YOUR CHILD... HAVE ANY OF THE FOLLOWING SPECIAL MEDICAL CONDITIONS OR CHRONIC ILLNESSES? ASTHMA DIABETES SIEZURES ECZEMA OTHER NONE REQUIRE MEDICATION(S) FOR MEDICAL CONDITIONS OR CHRONIC ILLNESS? YES NO HAVE ANY SPECIAL EQUIPMENT FOR A MEDICAL CONDITION OR CHRONIC ILLNESS? YES NO HAVE ANY ALLERGIC REACTIONS TO THE FOLLOWING? FOOD MEDICATION ENVIRONMENT OTHER NONE HAVE ANY DIETARY RESTRICTIONS? YES NO HAVE ANY OF THE FOLLOWING SPECIAL NEEDS? VISION HEARING SPEECH COGNITIVE FINE MOTOR GROSS MOTOR SOCIAL EMOTIONAL/BEHAVIORAL OTHER NONE FUNCTION AT THE DEVELOPMENTAL LEVEL OF OTHERS HIS/HER AGE? YES NO HAVE ANY IEP/IFSP? YES NO HAVE A THERAPIST(S) OR OTHER SUPPORT SERVICES? YES NO HAVE TOILET TRAINING? YES NO Is there any information about this child s health, special needs or development, that this school would need in the event of an emergency? A physical assessment form must be printed out and completed by the child s primary physician. A link to the document can be found here. FORM OF PAGE 5

Kiddie Tech University Learning Center

Kiddie Tech University Learning Center APPLICATION FOR ADMISSION Kiddie Tech University Learning Center Child s Name: Known As: Sex: Age: Yrs: Mos Date of Birth: Home Address: Home Phone: Name of Mother: Name of Father: Mother s Employer: Father

More information

ENROLLMENT AGREEMENT

ENROLLMENT AGREEMENT ENROLLMENT AGREEMENT Completion of this Agreement is required for enrollment. This information is necessary for First Steps Early Childhood Learning Center to comply with the State of Missouri Child Care

More information

YMCA After School Service Quality Program Designed for Children

YMCA After School Service Quality Program Designed for Children Quality Program Designed for Children MISSION STATEMENT It is the mission of the YMCA to put Christian principles into practice through programs that build a healthy spirit, mind, and body for all. YMCA

More information

Helen Troum Nursery and Kindergarten at Temple Beth Sholom 40-25 Fair Lawn Ave, Fair Lawn, NJ 07410 201 797-2865

Helen Troum Nursery and Kindergarten at Temple Beth Sholom 40-25 Fair Lawn Ave, Fair Lawn, NJ 07410 201 797-2865 Helen Troum Nursery and Kindergarten at Temple Beth Sholom 40-25 Fair Lawn Ave, Fair Lawn, NJ 07410 201 797-2865 dlesnoytbs@yahoo.com Enrollment Contract and Registration Form 2016-2017 School Year I hereby

More information

Academy of Learners ADMISSION INFORMATION Contract For Care January to December 2017

Academy of Learners ADMISSION INFORMATION Contract For Care January to December 2017 Contract For Care Aug 2010 / Pg 1 of 7 Full of Admission of Birth This child care agreement is between (facility) and the parents of the child(ren) enrolled. Care will be provided by the director Leslie

More information

ENROLLMENT REGISTRATION INFORMATION

ENROLLMENT REGISTRATION INFORMATION Pages 1 and 2 must be updated every January and July. Picture Parent Updates (Signature) (Date) Parent Updates (Signature) (Date) Parent Updates (Signature) (Date) School Code: Date of Registration: Date

More information

East High School Early Childhood Education Training Lab Parent / Guardian Policy Manual and Guidebook

East High School Early Childhood Education Training Lab Parent / Guardian Policy Manual and Guidebook East High School Early Childhood Education Training Lab Parent / Guardian Policy Manual and Guidebook East High School Early Childhood Education Training Lab Parent/Guardian Policy Manual and Guidebook

More information

List telephone numbers below where parents/guardian may be reached during their time with Wonderland Montessori.

List telephone numbers below where parents/guardian may be reached during their time with Wonderland Montessori. 1 Director s name: Date of Admission: Date of Withdrawal: Child s Full Name: Child s Home Address: Child s Home Phone Number: Date of birth: Child s nickname: PARENT INFORMATION: List telephone numbers

More information

Montessori Children s House Registration Form. Child s Name: Start date: Place of Employment. Place of Employment

Montessori Children s House Registration Form. Child s Name: Start date: Place of Employment. Place of Employment Montessori Children s House Registration Form Child s Name: Start date: Date of Birth: Nickname: Mother s Name: Mother s Address: Contact Numbers Place of Employment Work Address Work Phone Social Security

More information

Please be advised that monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments.

Please be advised that monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments. Brick Township Public Schools Brick Extended School Time Before and After School Care & Kindergarten Wrap Around 224 Chambers Bridge Rd - Brick, NJ 08723-732-262-2590 ext. 1531 BEST Program Families: Thank

More information

Children are this Community s Most Important Resource. Putnam County Board of Education. School Age Care PARENT HANDBOOK

Children are this Community s Most Important Resource. Putnam County Board of Education. School Age Care PARENT HANDBOOK Children are this Community s Most Important Resource Putnam County Board of Education School Age Care PARENT HANDBOOK The Putnam County School Age Care Program (SAC) is a parent-tuition funded group childcare

More information

Enrollment Form 2014-2015

Enrollment Form 2014-2015 Please print clearly in blue or black ink. Enrollment Form 2014-2015 Child s Full Name: Birth Date: Address: Home Phone: ( ) City: State: Zip Code: Nickname: Pick-up Password: Enrollment options: Wednesday

More information

UNIVERSITY OF NEBRASKA AT OMAHA CHILD CARE CENTER CONTRACT/AGREEMENT

UNIVERSITY OF NEBRASKA AT OMAHA CHILD CARE CENTER CONTRACT/AGREEMENT UNIVERSITY OF NEBRASKA AT OMAHA CHILD CARE CENTER CONTRACT/AGREEMENT I agree to pay on the first day my child(ren) attends the center, a weekly tuition fee of $, with no deductions for absences or non-major

More information

Natalie Brutto Infant and Toddler Provider 840 Hayes St. Apt. 3 San Francisco, CA 94117 PH: 415-863-4642 Fax: 415-874-9282 nbrutto@aol.

Natalie Brutto Infant and Toddler Provider 840 Hayes St. Apt. 3 San Francisco, CA 94117 PH: 415-863-4642 Fax: 415-874-9282 nbrutto@aol. Natalie Brutto Infant and Toddler Provider 840 Hayes St. Apt. 3 San Francisco, CA 94117 PH: 415-863-4642 Fax: 415-874-9282 nbrutto@aol.com PARENT HANDBOOK Dear Parent/Guardian: Welcome to Giggles Galore!

More information

Maple Tree Childcare Center Tuition Schedule School Year (Beginning the week of September 5, 2016)

Maple Tree Childcare Center Tuition Schedule School Year (Beginning the week of September 5, 2016) Maple Tree Childcare Center Tuition Schedule 2016-2017 School Year (Beginning the week of September 5, 2016) To enroll a new child in the program, please submit the registration fee of $85 plus payment

More information

COLUMBIA ELEMENTARY ASTRO SUMMER CAMP May 31 through July 22, 2016

COLUMBIA ELEMENTARY ASTRO SUMMER CAMP May 31 through July 22, 2016 COLUMBIA ELEMENTARY ASTRO SUMMER CAMP May 31 through July 22, 2016 PURPOSE The purpose of the Madison City Schools Summer Day Program is to provide an exciting and enriching summer program in a safe and

More information

Learning Pathways Preschool Enrollment Application

Learning Pathways Preschool Enrollment Application Learning Pathways Preschool Enrollment Application Please check the location that you wish to enroll your child 4115 Jacksol Drive, San Jose 831 Malone Road, San Jose Program Enrollment (Please check one):

More information

2015-2016 PROGRAM REGISTRATION

2015-2016 PROGRAM REGISTRATION 2015-2016 PROGRAM REGISTRATION Thank you for considering Summit Christian Learning Center for your Child s Care and Education. Summit Christian Center s purpose is to connect people with God and others,

More information

FAMILY CHILD CARE ENROLLMENT PACKET F A C E S H E E T

FAMILY CHILD CARE ENROLLMENT PACKET F A C E S H E E T Children s Records must be maintained for at least five (5) years after a child has left the program FAMILY CHILD CARE ENROLLMENT PACKET F A C E S H E E T Please fill out these forms completely. If a question

More information

After School Parent Handbook Dean Road Elementary School

After School Parent Handbook Dean Road Elementary School After School Parent Handbook Dean Road Elementary School 2013 2014 Program Coordinator: LaTara Hardnett After School Phone: 887-4909 Office Hours: 1:00 6:00 Program Hours: 2:20 5:30 lhardnett@auburnschools.org

More information

Citibank Family Center Back-up Care

Citibank Family Center Back-up Care Dear Citibank Employee: Citibank Family Center Back-up Care 4800 North 4th Avenue Sioux Falls, SD 57104 Phone (605)731-3777 Fax (605)731-3775 Thank you for your interest in the Citibank Family Center back-up

More information

CERTIFIED FAMILY CHILD CARE CONTRACT

CERTIFIED FAMILY CHILD CARE CONTRACT CERTIFIED FAMILY CHILD CARE CONTRACT Welcome! I am glad you have decided to enroll your child in my Certified Family Child Care. Should you have any concerns or wish to check the status of my Certification,

More information

Little Learners Early Childhood Center Making Memories, Marking Milestones

Little Learners Early Childhood Center Making Memories, Marking Milestones Little Learners Early Childhood Center Making Memories, Marking Milestones Welcome to Little Learners. We are so excited to be enrolling your child in our program. At Little Learners, your child will have

More information

Dear Corner Stone Charter Parent:

Dear Corner Stone Charter Parent: Dear Corner Stone Charter Parent: Welcome to Boll Family YMCA s School Age Child Care (SACC) program. We are looking forward to sharing the next 11 months with your child before and after school. Attached

More information

CHITIMACHA TRIBAL SCHOOL. AFTER SCHOOL CARE PROGRAM Beginning Monday, August 17, 2015 ENROLLMENT PACKET 2015-2016

CHITIMACHA TRIBAL SCHOOL. AFTER SCHOOL CARE PROGRAM Beginning Monday, August 17, 2015 ENROLLMENT PACKET 2015-2016 CHITIMACHA TRIBAL SCHOOL AFTER SCHOOL CARE PROGRAM Beginning Monday, August 17, 2015 ENROLLMENT PACKET 2015-2016 After School Care Program Registration Please read and complete all information contained

More information

FREQUENTLY ASKED QUESTIONS

FREQUENTLY ASKED QUESTIONS FREQUENTLY ASKED QUESTIONS ENROLLMENT INFORMATION What is the relationship between Rice University and the Rice Children s Campus? Rice University is committed to expanding the availability of high quality

More information

Child s Enrollment Form

Child s Enrollment Form The Commonwealth of Massachusetts Department of Early Education and Care Child s Enrollment Form Child Information Child s Name: Date of Birth: Age at Admission: Date of Admission: Child s Home Address:

More information

LR Pre-School (dba Lake Ronkonkoma Pre-School) ST. LAWRENCE THE MARTYR CHURCH SCHOOL 200 W. MAIN STREET, SAYVILLE, NY 11782 TEL.

LR Pre-School (dba Lake Ronkonkoma Pre-School) ST. LAWRENCE THE MARTYR CHURCH SCHOOL 200 W. MAIN STREET, SAYVILLE, NY 11782 TEL. REGISTRATION CHECKLIST 3 5 Ye a r O l d C l a s s e s Dear Mr./Mrs./Ms. Date We would like to welcome you and your child to the Lake Ronkonkoma Preschool. In order to have your child registered properly,

More information

THE FAMILY OF FAITH PRESCHOOL REGISTRATION FORM

THE FAMILY OF FAITH PRESCHOOL REGISTRATION FORM THE FAMILY OF FAITH PRESCHOOL REGISTRATION FORM 2014-2015 The Family of Faith, 16710 FM 529, Houston, TX 77095, Phone 281-855-2950 Fax 281-855-8301 E-mail: preschool@thefamilyoffaith.org Web Site: www.tfof.org

More information

Kids R Kids Mableton Student Enrollment Application. Primary Guardian Information

Kids R Kids Mableton Student Enrollment Application. Primary Guardian Information Start Date: Estimated Due Date: Child s Full Name: (Last, First, Middle) Child s Date of Birth: Current Age: Sex of Child: Male/Female Primary Guardian Information Name of Primary Guardian: Relation: (Primary

More information

WATERVLIET CIVIC CENTER BEFORE & AFTER SCHOOL PROGRAM SCHOOL-AGE CHILD CARE PROGRAM 2015-2016 APPLICATION. D.O.B. SEX: GRADE (in Sept.

WATERVLIET CIVIC CENTER BEFORE & AFTER SCHOOL PROGRAM SCHOOL-AGE CHILD CARE PROGRAM 2015-2016 APPLICATION. D.O.B. SEX: GRADE (in Sept. WATERVLIET CIVIC CENTER BEFORE & AFTER SCHOOL PROGRAM SCHOOL-AGE CHILD CARE PROGRAM 2015-2016 APPLICATION CHILD NAME: ADDRESS: CITY: D.O.B. SEX: GRADE (in Sept. 2015): MOTHER S NAME: ADDRESS: CITY: STATE:

More information

CHASE LEARNING CENTER & DAYCARE, INC. OPERATING POLICIES & PROCEDURES

CHASE LEARNING CENTER & DAYCARE, INC. OPERATING POLICIES & PROCEDURES 330 CANYON PARK DRIVE, PELHAM, AL 35124 (205) 620-1616 BUSINESS (205) 620-1549 FAX CHASE LEARNING CENTER & DAYCARE, INC. OPERATING POLICIES & PROCEDURES I. Purpose: To provide a wholesome Christian environment

More information

ENROLLMENT INSTRUCTIONS

ENROLLMENT INSTRUCTIONS ENROLLMENT INSTRUCTIONS Thank you for your interest in Little Tyke Creative Child Care. The steps below will walk you through our online enrollment process: STEP 1 Contact one of the center directors in

More information

Saint Raphael s School Extended Day Program Handbook 7301 Bass Lake Road Crystal, MN 55428

Saint Raphael s School Extended Day Program Handbook 7301 Bass Lake Road Crystal, MN 55428 Saint Raphael s School Extended Day Program Handbook 7301 Bass Lake Road Crystal, MN 55428 Hours: 2:15 pm 5:00 pm Phone: School Office 763.504.9450 (Eds/Qest ext 315) Kari Marsh, Program Director Saint

More information

Summer Camp 2016 VOLUNTEER APPLICATION

Summer Camp 2016 VOLUNTEER APPLICATION Summer Camp 2016 VOLUNTEER APPLICATION Student Name: Address: City/State/Zip: T-Shirt Size: Phone: E-mail: School: Current Grade: Current Age: Parent s Names: Parent s Cell Phone: Parent s E-mail: Have

More information

Pre-Registration Information

Pre-Registration Information Take a Close Look at the Fitzsimons Early Learning Center Pre-Registration Information The Fitzsimons Early Learning Center s pre-registration sessions have been planned. During these sessions, Bright

More information

KIDS CLUB HANDBOOK 2015/2016

KIDS CLUB HANDBOOK 2015/2016 KIDS CLUB HANDBOOK 2015/2016 Homework Time, Social Time, and Activity Time! February 2015 Letter from the Manager Dear Parents: The Glencoe Park District is excited to introduce Kids Club! Kids Club is

More information

Tennessee State University Department of Speech Pathology & Audiology Intensive Articulation, Fluency, Language & Diagnostics Summer Speech Camp

Tennessee State University Department of Speech Pathology & Audiology Intensive Articulation, Fluency, Language & Diagnostics Summer Speech Camp Tennessee State University Department of Speech Pathology & Audiology Intensive Articulation, Fluency, Language & Diagnostics Summer Speech Camp Speech Pathology and Audiology will provide intensive therapeutic

More information

Enrollment & Agreement/Policy Forms

Enrollment & Agreement/Policy Forms Enrollment & Agreement/Policy Forms Today s Date Day(s) of Week Care Needed Date Care to Begin Monday Tuesday Wednesday Thursday Friday Time(s) (write in beneath the day to which it pertains) Child s Full

More information

Sanford-Springvale YMCA Kids Out Enrichment Program 2016/17 Registration Form

Sanford-Springvale YMCA Kids Out Enrichment Program 2016/17 Registration Form 2016/17 Registration Form SAD57 Program Information (Non-refundable registration fee of $25 for NEW participants required at time of registration): Before Care Program Sites (Please circle one) Alfred

More information

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR

GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR GLOBAL TECH ACADEMY INC. AFTERSCHOOL ENRICHMENT PROGRAM REGISTRATION PACKET FOR 2015-2016 SCHOOL YEAR Welcome Child s Enrollment Form Parent Pick-Up Authorization Emergency Information, Waiver & Medical

More information

Hopeful Lutheran Preschool 2 & 3 Year Old Daily Routine

Hopeful Lutheran Preschool 2 & 3 Year Old Daily Routine Hopeful Lutheran Preschool 2 & 3 Year Old Daily Routine 9:00 9:25 Free Choice Children choose any activity he/she wishes. (art center, dramatic play center, science center, etc.) 9:25 9:40 Bible Time Pledge

More information

Early Childhood Laboratory School A Reach Toward Excellence

Early Childhood Laboratory School A Reach Toward Excellence Early Childhood Laboratory School A Reach Toward Excellence Department of Education Education & Humanities Building Dover, Delaware 19901 (302) 857-6731 Enrollment Packet Child's First Name: Last Name:

More information

E arly C hildhood E ducation

E arly C hildhood E ducation Child's Last Name, First Name: Grade: The Seven Hills School E arly C hildhood E ducation State Mandated Documentation Instructions and Forms Dear Parents: Enclosed you will find the paperwork required

More information

Enrollment Application

Enrollment Application Solid Rock Christian Preschool A Ministry of Solid Rock Worship Center, Inc. Date of Enrollment: Class: Student Information Last First Middle Street City State/Zip Date of Birth: Sex: M F Primary Hours

More information

Johns Creek Montessori School Of Georgia

Johns Creek Montessori School Of Georgia ENROLLMENT FORM Pre-Primary (Toddler) Primary Half Day Full Day All Day Start : Child s Information: Child s Name Street Address Nickname of Birth Subdivision Name Primary Language Spoken Parent/Guardian

More information

Address: Street City State Zip Code Home Phone: E-mail Address:

Address: Street City State Zip Code Home Phone: E-mail Address: SANDWICH CUSD #430 REGISTRATION FORM SCHOOL YEAR 2013-2014 SELECT AN ATTENDANCE CENTER LG Haskin Prairie View WW Woodbury HE Dummer Middle School High School 1. NAME: 5. SEX: Male Female Last Name First

More information

This Order is effective beginning.

This Order is effective beginning. CASE NUMBER PARENTING TIME GUIDELINES FOR THE NON-RESIDENTIAL PARENT The Domestic Relations Court has developed these parenting time schedules for the purpose of assisting divorcing parents in formulating

More information

CAO FL-3 PARENTING PLAN. The parents (Father) and (Mother) shall spend time with their children: Date of Birth

CAO FL-3 PARENTING PLAN. The parents (Father) and (Mother) shall spend time with their children: Date of Birth CAO FL-3 PARENTING PLAN The parents (Father) and (Mother) shall spend time with their children: Name as follows: Date of Birth 1. PARENT RESPONSIBILTIES When each child is in a parent s physical custody,

More information

Registration 2012 Summer (Available 7am - 6pm) Child s Full Name: Name Used: Date of Birth: Gender: Grade: Full Address:

Registration 2012 Summer (Available 7am - 6pm) Child s Full Name: Name Used: Date of Birth: Gender: Grade: Full Address: ZION CHRISTIAN CHILDREN S CENTER SCHOOL AGE SUMMER CAMP Zion United Methodist Church ~ 1674 Zion Road Troy, VA 22974 (434) 906-5494 ~ ZionUMCAfterschool@gmail.com Registration 2012 Summer (Available 7am

More information

Valley Farm Daycare Centre

Valley Farm Daycare Centre Welcome to Valley Farm Daycare Centre www.valleyfarmdaycare.com 1995 Valley Farm Rd. Pickering, Ontario L1V 1X6 (905) 839-5726 POLICIES AND PROCEDURES Open Door Policy As a daycare that is proud of what

More information

2016 CAMP DISCOVERY REGISTRATION

2016 CAMP DISCOVERY REGISTRATION 2016 CAMP DISCOVERY REGISTRATION We must have 2 weeks written notice prior to a child canceling camp or you will be charged the full amount Please print all information clearly (blue or black pen only)

More information

GCA Summer Camp 2016 Overview

GCA Summer Camp 2016 Overview GCA Summer Camp 2016 Overview Ages: Preschool to 6th Grade Registration Fee: FREE if registered by May 2nd; $15 per week if registered after May 2nd. Tuition Fee: $125 per weekly session.* This includes

More information

Grandview Early Learning Center Puyallup Tribal Preschool Program APPLICATION

Grandview Early Learning Center Puyallup Tribal Preschool Program APPLICATION APPLICATION PUYALLUP TRIBE OF INDIANS 3580 E Grandview Ave Tacoma, WA 98404 253-680-5515 office 253-680-5517 fax The following must be attached to this application: o Tribal Identification for the child.

More information

Community Action Partnership of Lake County Head Start Program 1200 Glen Flora Waukegan, Illinois (847)

Community Action Partnership of Lake County Head Start Program 1200 Glen Flora Waukegan, Illinois (847) Community Action Partnership of Lake County Head Start Program 1200 Glen Flora Waukegan, Illinois 60085 (847) 249-4330 www.caplakecounty.org Thank you for your interest in the Head Start Program. Our program

More information

PROVIDER-PARENT/GUARDIAN CHILD CARE CONTRACT

PROVIDER-PARENT/GUARDIAN CHILD CARE CONTRACT PROVIDER-PARENT/GUARDIAN CHILD CARE CONTRACT Welcome! I m glad you have decided to enroll your child in my family daycare. (You are welcome to contact 4-C certification, who I am certified through (271-9181)

More information

Child s date of birth: d d / m m / y y y y Male Female. Iwi your child belongs to:

Child s date of birth: d d / m m / y y y y Male Female. Iwi your child belongs to: Enrolment Agreement Enrolment Checklist: Official Identity Document Supplied Immunisation Document Supplied Other Enrolment Fee Paid Bond Paid (Amount Due $ ) Staff initials: Child s details: Child s official

More information

PEMBROKE PINES CHARTER ELEMENTARY/MIDDLE SCHOOL CENTRAL & WEST AFTER SCHOOL CARE PROGRAM 2013/2014

PEMBROKE PINES CHARTER ELEMENTARY/MIDDLE SCHOOL CENTRAL & WEST AFTER SCHOOL CARE PROGRAM 2013/2014 Dedicated to providing a high quality education to a diverse community where all students are expected to succeed as life-long learners. PEMBROKE PINES CHARTER ELEMENTARY/MIDDLE SCHOOL CENTRAL & WEST AFTER

More information

STATEMENT OF BENEFITS FOR AT-WILL EMPLOYEES

STATEMENT OF BENEFITS FOR AT-WILL EMPLOYEES STATEMENT OF BENEFITS FOR AT-WILL EMPLOYEES VACATION/ANNUAL Vacation is earned during actual time worked and during paid medical leave, vacation time, holidays and leaves of absence with pay. Vacation

More information

2210 High Tech Road, State College, PA 16803 814-357-6898 fax 814-357-6897 www.pennskates.com

2210 High Tech Road, State College, PA 16803 814-357-6898 fax 814-357-6897 www.pennskates.com Dear Summer Camp Parents, 2210 High Tech Road, State College, PA 16803 814-357-6898 fax 814-357-6897 www.pennskates.com Welcome to our 2015 Summer Day Camp program! Your children will have the opportunity

More information

Mothercraft Ottawa, Evered Avenue Program Parent Handbook

Mothercraft Ottawa, Evered Avenue Program Parent Handbook Mothercraft Ottawa, Evered Avenue Program Parent Handbook Established in 1944, Mothercraft Ottawa is a well-respected family service and early learning centre in the Ottawa community. Our mission is to

More information

Welcome Letter. Please request the current Tuition and Fee Schedule Form directly from the campus location you are interested in enrolling your child.

Welcome Letter. Please request the current Tuition and Fee Schedule Form directly from the campus location you are interested in enrolling your child. Welcome Letter Dear Parent, Thank you for considering Castle Montessori for your child! Castle Montessori's academic philosophy is based on authentic Montessori principles for students ranging from toddlers

More information

Parent / Provider Contract

Parent / Provider Contract Ascension Before & After School Care Ascension is called to be a family of faith so reflecting the life of Christ, that we draw all people to Him. Parent / Provider Contract This contract is between, parent(s)

More information

ABSENCE FROM WORK ABSENCE FROM WORK

ABSENCE FROM WORK ABSENCE FROM WORK ABSENCE FROM WORK Revised 12/17/2015 Employee Handbook: Absence From Work 1 of 11 VACATION To define time-off from regular work hours. It is company policy to grant time off from work under specific rules

More information

Annual Enrollment Application and Contract (For Preschool-age and older)

Annual Enrollment Application and Contract (For Preschool-age and older) Annual Enrollment Application and Contract (For Preschool-age and older) Child's Name: Date of Birth: Phone Number: City: State: Zip Code: Session (F)ull or (P)art Time Arrival Time Departure Time Rate

More information

MISSION STATEMENT PHILOSOPHY

MISSION STATEMENT PHILOSOPHY MISSION STATEMENT The Cranston Public School District s mission of inclusion, through a partnership involving regular education, special education, and families is to set appropriate challenges and goals

More information

ADMISSION PROCESS. Please note that we will only accept a complete application package.

ADMISSION PROCESS. Please note that we will only accept a complete application package. Welcome to the Surrey Muslim School! ADMISSION PROCESS We are delighted that you are considering Surrey Muslim School for your child. To apply for admission of your child, please fill an application form,

More information

AFTER SCHOOL PROGRAM CHILD'S FACE SHEET/ENROLLMENT FORM

AFTER SCHOOL PROGRAM CHILD'S FACE SHEET/ENROLLMENT FORM CHILD'S FACE SHEET/ENROLLMENT FORM CHILD INFORMATION Child's Name: Date of Birth: Home Address: Telephone: School attending for 2014/15 school year: Primary Language: Child's Identifying Information (required

More information

Pierre Elliott Trudeau Elementary School Daycare

Pierre Elliott Trudeau Elementary School Daycare Pierre Elliott Trudeau Elementary School Daycare The Western Quebec School Board offers Daycare Services to its students in schools where the demand warrants such a service. These services are offered

More information

Early Learning Center for Research and Practice Parent Handbook Policies. Inclement Weather Policy

Early Learning Center for Research and Practice Parent Handbook Policies. Inclement Weather Policy Inclement Weather Policy The University of Tennessee does not close except in the most severe weather conditions. In most cases, the Early Learning Center will comply with the University of Tennessee s

More information

Oasis Christian Youth Ministry Presents Camp H2O Summer Reading Enrichment Program 4524 East Brookstown Dr. Baton Rouge, LA 70805

Oasis Christian Youth Ministry Presents Camp H2O Summer Reading Enrichment Program 4524 East Brookstown Dr. Baton Rouge, LA 70805 Oasis Christian Youth Ministry Presents Camp H2O Summer Reading Enrichment Program 4524 East Brookstown Dr. Baton Rouge, LA 70805 Are you looking for a summer of reading enrichment and fun???? Then look

More information

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes) Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation

More information

STEPS TO ADMISSION We recommend that interested parents schedule a campus tour.

STEPS TO ADMISSION We recommend that interested parents schedule a campus tour. So the generations to come might know Him Psalm 78:4 STEPS TO ADMISSION We recommend that interested parents schedule a campus tour. Application Process 1. Complete and return the application with the

More information

New Student Registration Forms. Registration Checklist

New Student Registration Forms. Registration Checklist New Student Registration Forms Registration Checklist To be completed only if offered a spot Please print these registration documents All forms should be completed in full The following list includes

More information

Pre-Kindergarten Program Family Handbook. Champaign Early Childhood Center 809 N. Neil Street Champaign, Illinois (217)

Pre-Kindergarten Program Family Handbook. Champaign Early Childhood Center 809 N. Neil Street Champaign, Illinois (217) Pre-Kindergarten Program Family Handbook Champaign Early Childhood Center 809 N. Neil Street Champaign, Illinois 61820 (217) 351-3881 Champaign Pre-K Mission Statement We believe all students can learn.

More information

International Student Guidelines and Requirements

International Student Guidelines and Requirements International Student Guidelines and Requirements 1. Prince of Peace Christian School will consider international applicants. a. Lower school students (through 5 th grade) must live with a parent. b. Middle

More information

Child s Name: Address : City: Zip:

Child s Name: Address : City: Zip: Child s Name: Address : City: Zip: Home phone: Cell: Child birth date: Child age: Parent s Name: Parent birth date: Person Responsible for child: Additional Persons who may be called in an Emergency Name

More information

Breakfast & Teddies After School Club

Breakfast & Teddies After School Club West Sussex County Council HANDCROSS PRIMARY SCHOOL London Road, Handcross, Haywards Heath, West Sussex RH17 6HB Telephone: (01444) 400291 Fax: (01444) 401176 Email: office@handcross.w-sussex.sch.uk Website:

More information

SACRED HEART DAYCARE. 455 Pigeon Avenue Williams Lake, BC V2G4R Parent Handbook

SACRED HEART DAYCARE. 455 Pigeon Avenue Williams Lake, BC V2G4R Parent Handbook SACRED HEART DAYCARE 455 Pigeon Avenue Williams Lake, BC V2G4R5 250-398-5852 www.sacredheartwl.com Parent Handbook Sacred Heart Daycare Parent Handbook Dear Parent/Guardian: Enclosed are the policies for

More information

Daily Homework Help Time Outdoor Games Warm & Caring Environment Friendly & Qualified Staff Theme-Based Curriculum Arts & Crafts

Daily Homework Help Time Outdoor Games Warm & Caring Environment Friendly & Qualified Staff Theme-Based Curriculum Arts & Crafts GENERAL INFORMATION AFTER SCHOOL 2015-16 After School Programs are provided for youth who attend school in the Town of Amherst. The program operates Monday Friday from 2:00-5:30pm. An Extended Afternoon

More information

City of Gulfport Recreation Division, 5730 Shore Blvd. S., Gulfport, Florida 2016 Summer Program READ/SIGN THIS PAGE BEFORE CONTINUING

City of Gulfport Recreation Division, 5730 Shore Blvd. S., Gulfport, Florida 2016 Summer Program READ/SIGN THIS PAGE BEFORE CONTINUING City of Gulfport Recreation Division, 5730 Shore Blvd. S., Gulfport, Florida 2016 Summer Program READ/SIGN THIS PAGE BEFORE CONTINUING EARLY LEARNING COALITION PARENTS ONLY ELC payments are due on Friday

More information

YMCA OF GREATER NEW YORK SUMMER CAMP REGISTRATION FORM

YMCA OF GREATER NEW YORK SUMMER CAMP REGISTRATION FORM YMCA OF GREATER NEW YORK SUMMER CAMP REGISTRATION FORM Branch: North Brooklyn YMCA Camp Site: North Brooklyn Branch Camp Type: PARTICIPANT INFO Child s Name Age D.O.B. Gender Grade in September 2016 School

More information

WESTWOOD PRESCHOOL HANDBOOK 2014-2015

WESTWOOD PRESCHOOL HANDBOOK 2014-2015 WESTWOOD PRESCHOOL HANDBOOK 2014-2015 Hello! My name is Harshal Patwa and I am honored to be part of Poway Preschool. I love working with young children, and I love learning from them too. I have been

More information

TRENT INTERNATIONALE SCHOOL LOWER SCHOOL APPLICATION. Trent InternationalE School Established For School Official ONLY. Date of Admission:

TRENT INTERNATIONALE SCHOOL LOWER SCHOOL APPLICATION. Trent InternationalE School Established For School Official ONLY. Date of Admission: TRENT INTERNATIONALE SCHOOL LOWER SCHOOL APPLICATION Testing date Name of Student Grade for 2015-2016 Date of Application For School Official ONLY Date of Admission: Date of Withdrawal: Admission s Procedure:

More information

CHILD S FACE SHEET/ENROLLMENT FORM INFANT/TODDLER

CHILD S FACE SHEET/ENROLLMENT FORM INFANT/TODDLER CHILD S FACE SHEET/ENROLLMENT FORM INFANT/TODDLER CHILD INFORMATION: Child s Name: Date of Birth Home Address: Place of Birth:(city/town) Telephone: Primary Language: Child s Identifying Information (required

More information

Harmony Early Childhood Education Center Registration Form

Harmony Early Childhood Education Center Registration Form Harmony Early Childhood Education Center Registration Form Today s date: Starting date: Case #: Child s Name: Classroom: (First Name) (Last Name) Date of birth: Home Phone: Gender: Boy Girl Mom s Work

More information

Schooner SULTANA Middle School 5-Day Trips 2016

Schooner SULTANA Middle School 5-Day Trips 2016 Updated Nov., 2015 Summer Program Forms Packet for Schooner SULTANA Middle School 5-Day Trips 2016 Forms for Your Reference Pick-Up & Drop-Off Information-page 2 Packing List - page 3 Forms That Must Be

More information

OUR MISSION. To promote and encourage Independent, successful, leaders of tomorrow- with open hearts and open minds!

OUR MISSION. To promote and encourage Independent, successful, leaders of tomorrow- with open hearts and open minds! OUR MISSION To promote and encourage Independent, successful, leaders of tomorrow- with open hearts and open minds! VISION STATEMENT We are here to help guide our youth into becoming passionate leaders

More information

STEP 2: Please complete the Special Needs and Circumstances Section. STEP 3: Please take a moment to complete our questionnaire.

STEP 2: Please complete the Special Needs and Circumstances Section. STEP 3: Please take a moment to complete our questionnaire. New Rising Star Missionary Baptist Church Rising Stars Enrichment Program Registration Packet 7400 London Avenue, Eastlake Birmingham, Alabama 35206 Phone: (205) 833-3676 Email Address: risingstarscamp@nrschurch.org

More information

Jacob s Ladder Pediatric Rehabilitation Center, Inc. Child Respite Program

Jacob s Ladder Pediatric Rehabilitation Center, Inc. Child Respite Program Page 1 of 5 Intake Sheet Child s Name #1 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Child s Name #2 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Father/Mother/Guardian:

More information

RAVENSDALE PRIMARY SCHOOL NURSERY CLASS & PLAYGROUP AM ADMISSION FORM

RAVENSDALE PRIMARY SCHOOL NURSERY CLASS & PLAYGROUP AM ADMISSION FORM RAVENSDALE PRIMARY SCHOOL NURSERY CLASS & PLAYGROUP AM ADMISSION FORM If you would like this form to be reproduced in a language other than English, please notify the school office. Child s legal surname:

More information

Information sheet: Kindertagesstätte Leuehöhli

Information sheet: Kindertagesstätte Leuehöhli Information sheet: Kindertagesstätte Leuehöhli The thkt familienservice GmbH-managed Kindertagesstätte Leuehöhli provides childcare services outside the family. Leuehöhli furnishes its children with an

More information

APPLICATION FOR GENERAL EMPLOYMENT

APPLICATION FOR GENERAL EMPLOYMENT APPLICATION FOR GENERAL EMPLOYMENT Please Print REVISED 12/04 Human Resources P.O. Box 429, Biloxi, MS 39533 Telephone (228) 435-6259 Fax (228) 435-6409 http://biloxi.ms.us Date of Application: Social

More information

SAMPLE CONTRACT PARENT PROVIDER MUTUAL AGREEMENT FORM: The following is an agreement between and. for child(ren) in care: Name(s) of child(ren) age(s)

SAMPLE CONTRACT PARENT PROVIDER MUTUAL AGREEMENT FORM: The following is an agreement between and. for child(ren) in care: Name(s) of child(ren) age(s) SAMPLE CONTRACT Name of Program: Date: PARENT PROVIDER MUTUAL AGREEMENT FORM: The following is an agreement between and parent provider for child(ren) in care: Name(s) of child(ren) age(s) This agreement

More information

Little Einsteins Daycare @ St. Albert Inc. 22 Sir Winston Churchill Avenue, St. Albert, AB T8N 1B4 Phone: 780-486-6740

Little Einsteins Daycare @ St. Albert Inc. 22 Sir Winston Churchill Avenue, St. Albert, AB T8N 1B4 Phone: 780-486-6740 Child s name: Date of registration: Starting Date: Child s age: Male Female Legal Guardian: Mother s Name: Email address: Mother s home phone: Cell # : Mother s place of work: Phone: Is mother allowed

More information

University Policy Number : POLICY ON FAMILY AND MEDICAL LEAVE ACT

University Policy Number : POLICY ON FAMILY AND MEDICAL LEAVE ACT University Policy Number 200.12: POLICY ON FAMILY AND MEDICAL LEAVE ACT Responsible Administrator: Office of the President Responsible Office: Office of Human Resources Originally Issued: August 2006 Revision

More information

BLOOMINGTON-NORMAL YMCA 2015 SUMMER CAMP PARENT HANDBOOK

BLOOMINGTON-NORMAL YMCA 2015 SUMMER CAMP PARENT HANDBOOK BLOOMINGTON-NORMAL YMCA 2015 SUMMER CAMP PARENT HANDBOOK Camp Sparrow: Be strong enough to stand Be free enough to soar About the YMCA The YMCA is for youth development, for healthy living, for social

More information

Gethsemane Lutheran School Early Childhood Education Handbook (Pre-K and Kindergarten)

Gethsemane Lutheran School Early Childhood Education Handbook (Pre-K and Kindergarten) Gethsemane Lutheran School Early Childhood Education Handbook (Pre-K and Kindergarten) Revised: July 2012 TABLE OF CONTENTS Subject Page Statement of Purpose... 2 Goals... 2 Curriculum... 3 Special Events...

More information

Childcare Registration and Agreement Form

Childcare Registration and Agreement Form Childcare Registration and Agreement Form Please complete this form and return it with the registration fee ( 30) and a refundable deposit of two weeks fees. This form must be completed by someone who

More information

Warden House Primary School. The Jungle Club. Breakfast Club, After School Club and Holiday Club. Birdwood Avenue, Deal, Kent CT14 9SF

Warden House Primary School. The Jungle Club. Breakfast Club, After School Club and Holiday Club. Birdwood Avenue, Deal, Kent CT14 9SF Warden House Primary School The Jungle Club Breakfast Club, After School Club and Holiday Club Birdwood Avenue, Deal, Kent CT14 9SF Telephone Number: 01304 375040 Option 3 Email Address: wendy.harvey@warden-house.kent.sch.uk

More information