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

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1 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 Kniskern and the co-director Sandra Mettler. Cancellation of Contract: This contract is valid from the date of enrollment until parents or caregiver provide written notice of withdrawal. Two (2) weeks notice must be provided by either caregiver or parent unless extreme circumstances are present (ie: child causing harm to other children or facility, death in family, etc). Terms of Contract Days and Hours of Care: Care will be provided on the days requested and for the hours of care specified. Early starts/late pick ups: (anytime before/after your regularly scheduled pick up time) will be charged a fee of $5.00 for every ½ hour you are early or late. This fee is automatically charged to your account and can be paid with Friday s tuition payment. Cash payment is also accepted. Tuition Payments: All tuition payments are due on Friday for the following weeks care. Tuition not paid by midnight on Friday will incur a $7.00 late fee. This fee will be applied daily at midnight until tuition is paid. Care will NOT be provided until tuition is paid. Child Tardies/Absences: Please notify us as soon as possible if your child is going to be late or absent so that we can adjust our meal prep and lesson prep accordingly. Tuition is charged regardless of your child s attendance. Meals and Snacks: All meals and snacks are included in your tuition. You are welcome to bring or provide meals if your child is on a specific diet. Formula is provided by parents. Holidays/Vacation/Closures: All holidays, training, and vacation days are listed on the parent portal. You are responsible for having backup care for your child. We reserve the right to use an additional 3 days a year (paid) for required training. All closure dates are listed at least 30 days in advance to provide adequate time for you to find backup care. From August to July the Academy takes 9 scheduled holidays (tuition paid) and 2 weeks of vacation (no tuition paid). Special Circumstances Tuition paid by more than one responsible party: If tuition will be split between responsible parties please be aware that ANY failure to pay tuition will cause the Academy to remove the child from enrollment. Divorced Parents: All pages will need to be filled out by the parent enrolling the child for care. If tuition will be split or days will differ between divorced or separated parents each parent will need to fill out a separate admission packet. A copy of your custody agreement must be on file in order to be enforced by local law enforcement and the Academy. Foster Parents: Page 7 will be placed in your family folder. Pages 1 to 6 will need to be filled out for each individual child that is placed with us. By signing this contract, I agree to abide by the terms listed above. I acknowledge receipt of the facility s ONLINE operational policies including those for discipline and guidance. I understand that a printed copy can be requested.

2 Full Aug 2010 / Pg 2 of 7 of Birth Current Age of Admission of Withdrawal Home Street Address Home City State Zipcode Home Hours in Care My child is normally in care on the following days and times: From To Monday Tuesday Wednesday Thursday Friday Tuition Rates Tuition below is for care provided for your scheduled hours. Full Time (Scheduled) Tuition is paid each week regardless of attendance, holidays, etc. $ per week $ per week Part Time (sibling) (Scheduled) Tuition is paid each week based on your reserved days regardless of attendance, holidays, etc. $36.00 per day $32.40 per day (sibling) Daily / Drop In (Varies) Tuition is paid based on your reserved days. Schedule varies and must be reserved by the parent. $36.00 per day $32.40 per day (sibling) Hourly Care Hours Hourly care is only available on school days between 8am and 3pm. $7.00 per hour Extended Care Hours When available Extended Care is provided before/after your scheduled care hours. $5.00 per half hour Drop In/Daily/Hourly or Extended Care RESERVATIONS No charge for reservations cancelled 48 hours prior to attendance. 50% cancellation fee charged for hour notice 100% cancellation fee charged for less than 24 hour notice.

3 Aug 2010 / Pg 3 of 7 Full of Admission of Birth Permission Forms By checking below I hereby GIVE my consent below for (check all that apply): Permission to transport children: for emergency care on field trips to and from school to and from home Permission for walking field trips to: the neighborhood local park Permission to participate in water activities: sprinkler play water table play splashing/wading pools Permission to take photos that will be: No identifying information will ever be posted in a public forum. posted on family album (private) used for crafts, games, education, etc. used in advertising (additional permission required) Meals Served I understand that the following meals will be served to my child while in care: Ages 1 to School Age Breakfast (8am) AM Snack (10am) Lunch (12pm) PM Snack (3:30pm) Supper (care scheduled past 6:00pm) Infants Breastmilk (provided by parent) Formula (provided by parent) Baby food (provided by The Academy) Immunization Record I have provided the childcare operation with a copy of my child s most current immunization record. IMPORTANT: Please attach a copy of your child s immunization AND any notes from your doctor regarding food allergies Child daycare operations are public accommodations under the Americans with Disabilities Act (ADA), Title III. If you believe that such an operation may be practicing discrimination in violation of Title III, you may call the ADA Information Line at (800) (voice) or (800) (TTY).

4 Full of Admission of Birth Aug 2010 / Pg 4 of 7 Medical Information List any special problems that your child may have, such as allergies, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term continuous use, and any other information which caregiver s should be aware of: School Age Children My child attends the following school: of School Address School Ph.# City State Zip CHECK ALL THAT APPLY: His / her immunization record is on file at the school and all required immunizations and/or tuberculosis test are current. Vision and Hearing screening records are also on file. of sibling(s): My child has permission to: walk to or from school or home, ride a bus, and/or be released to the care of his/her sibling(s) under 18 years old. Hearing and Vision Screening IMPORTANT: Must be completed at age 4 VISION R 20/ L 20/ PASS FAIL SIGNATURE DATE HEARING 1000 Hz 2000 Hz 4000 Hz R PASS FAIL L SIGNATURE DATE

5 Full of Admission of Birth Aug 2010 / Pg 5 of 7 Authorization for Emergency Medical Attention In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to: Physician Emergency Care Facility Hospital I give consent for the facility to secure any and all necessary emergency medical care for my child. Signature - Parent or Legal Guardian

6 Aug 2010 / Pg 6 of 7 Full of Admission of Birth Health and Medical Information ADMISSION REQUIREMENT: If your child does not attend school away from, one of the following must be presented when your child is admitted to the child-care operation or within one week of admission. 1. HEALTH-CARE PROFESSIONAL S STATEMENT: I have examined the above named child within the past year and find that he / she is able to take part in the day care program. Health Care Professional's Signature 2. A signed and dated copy of a health care professional s statement is attached. 3. Medical diagnosis and treatment conflict with the tenets and practices of a recognized religious organization, which I adhere to or am a member of; I have attached a signed and dated affidavit stating this. 4. My child has been examined within the past year by a health care professional and is able to participate in the day care program. Within 12 months of admission, I will obtain a health care professional s signed statement and will submit it to the child-care operation. Health care professional s statement must be submitted by. Health Care Professional that has seen your child in the past 12 months? Signature - Parent or Legal Guardian

7 Aug 2010 / Pg 7 of 7 Full of Admission of Birth Mother s/guardian Information Full Father s/guardian Information Full Home Address, City, State Zipcode Home Address, City, State Zipcode Address Address List telephone numbers below where parents/guardian may be reached while child will be in care Home Cellular No. Home Cellular No. Employer Information Employer Work No. Employer Work No. Work Address, City, State Zipcode Work Address, City, State Zipcode Emergency Contact Information Give the name, address and phone number of person to call in case of an emergency if parents / guardian cannot be reached. Use the back of the page to list additional people. RELEASE OF CHILDREN I hereby authorize the childcare operation to allow my child to leave the childcare operation ONLY with the following persons. Please list name & telephone number for each. Children will only be released to a parent or a person designated by the parent/guardian after verification of ID. Use the back of the page to list additional people. Full /Telephone #/Relationship Full /Telephone #/Relationship