Play and Learn Preschool

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1 Preschool classes Classes and ages for children resources for 3 parents to 5 years old as and their ofinfants, September toddlers 1and preschoolers Play and Learn Preschool (formerly School Readiness Preschool)

2 Welcome Play and Learn Preschool (formerly School Readiness Preschool) prepares children for kindergarten and encourages them to be enthusiastic learners - for life! Children ages 3-5 years old participate in hands-on fun and educational activities in a stimulating preschool classroom that encourages active learning through exploration. Play and Learn Preschool offers reduced preschool tuition for qualifying families, FREE bus transportation, FREE lunch is available for Play and Learn 4s, and snacks are served in all classes. Apply NOW for Play and Learn Preschool Children s Learning Play is an effective and enjoyable way for children to learn. Classroom activities promote: Language and literacy skills as they play games; sing songs; recite rhymes; read books; practice letter names and sounds; and write. Thinking skills as they construct with blocks; or work on puzzles; experiment with science and math. Small muscle skills when they string beads or make playdough shapes. Large muscle skills when they play ball; ride bikes; or run. Creative skills as they make up stories; paint at the easel; and make music. Social-emotional skills as they play ball games; make decisions in imaginative play; follow routines and rules; learn to understand their own feelings and how to get along with others. Licensed Minnesota Department of Education teachers use the following educational tools: Creative Curriculum for Preschool; ez Write; Jolly Phonics; SEEDS of Learning. Play and Learn Preschool Eligibility Preschool waivers or fees are determined by: Family Gross Annual Income of $59,500 or less and the number of people in the family. Lives in or attends home daycare in the Mounds View School District area. Complete application forms. Class placement is based on the child s needs. Confirmation s will be sent. Bus Transportation Play and Learn Preschool offers FREE bus transportation. Children attending PLEC for preschool must reside in or attend daycare in the Bel Air, Pinewood, Sunnyside, or Valentine Hills school attendance area. Children attending SLEC for preschool must reside in or attend daycare in the Island Lake or Turtle Lake school attendance area. Parent Information Nights Parents of children ages 3-5 years are invited to come see classrooms, meet teachers and hear about our preschool learning activities and parent education opportunities. April 18 Pike Lake Education Center 6:30-7:30 pm or April 20 6:30-7:30 pm Spanish interpreter Play and Learn Preschool Locations Pike Lake Education Center - PLEC th St NW New Brighton Snail Lake Education Center - SLEC 350 Highway 96 West Shoreview Sharon Savard, Play and Learn Preschool Supervisor

3 Pike Lake Education Center, New Brighton Play and Learn 3s For children 3 years old by September 1, T & TH AM PLEC T & TH AM PLEC M, W, F AM PLEC 1 Play and Learn 4s For children 4 years old by September 1, M, T, W, Th & F AM PLEC M, T, W, Th & F AM PLEC M, T, W, Th & F AM PLEC M, T, W, Th & F AM PLEC 44 Play and Learn 4s For children 4 years old by September 1, M, T, W, Th & F PM PLEC M, T, W, Th & F PM PLEC M, T, W, Th & F PM PLEC M, T, W, Th & F PM PLEC 1 Snail Lake Education Center, Shoreview Play and Learn 3s For children 3 years old by September 1, M, W & F AM SLEC 105 Play and Learn 4s For children 4 years old by September 1, M, T, W, Th & F AM SLEC M, T, W, Th & F PM SLEC M, T, W, Th & F PM SLEC 107 AM-Morning classes: 9:30 am to 12:15 pm PM-Afternoon classes: 1:25 pm to 4:10 pm Snack is served in all classes. Lunch is served in Play and Learn 4s classes. Four Family Events will be held during the school year. Your entire family is invited; parents are strongly encouraged to attend. Play and Learn Preschool Registration Form Mail forms and payment to Pike Lake Education Center Play and Learn Preschool th St NW New Brighton, MN Child's First Name Child's Last Name Birthdate Gender Parent's First Name Parent's Last Name Address City Zip Address for bus pick up Address for bus drop off Class Number Days Fee Visa, MasterCard, Discover (circle one) Expiration Code Signature Play and Learn Preschool Forms to complete and turn in: 1. registration form 2. eligibility form 3. tuition assistance form 4. proof of income 5. health/emergency form 6. immunization record Your child will be considered for entry into Play and Learn Preschool when all of the above forms are completed and returned to Pike Lake Education Center. Office use only: Date and time received Returning student? Questions? Contact Sharon at or

4 Early Childhood Screening Children enrolled in Play and Learn Preschool must complete a FREE Early Childhood Screening. Screening must be completed within the first three months of starting preschool. Screening gives you a good idea of how your child is growing and developing. To schedule your child s FREE appointment, call I learned practical parenting tips at a Family Night that really work with my child. Preschool Parent Parent Involvement The most important factor in predicting a child s success in school is parent involvement. Parents are an important part of our Play and Learn Preschool classes and can be involved by: attending Family Events with activity time and parent education. Parent attendance is strongly encouraged. setting up an Early Childhood Screening appointment for the child. attending two parent-teacher conferences checking out parent education books, children s books and toys from the Family Resource Center at no cost. At our family event, I was amazed at how all of the kids had learned to pass snack, pour their water, and interact with the other kids at the table. Preschool Parent Parent Education Parent Education discussion led by the Minnesota Department of Education licensed parent education teacher may include the following topics: * Social-Emotional Development * Brain Development * Temperament * Raising a Reader * Guiding Your Child s Behaviors * Parenting Styles * Early Math * Learning Styles * Parent s Role in School Success Initially my son was not very social, but now he enjoys making friends. Preschool Parent

5 Play and Learn Preschool Tuition Assistance Form Yearly tuition is divided into nine (9) equal payments. Tuition is due by the 10 th of each month from September to May Visa, MasterCard, Discover, cash or checks (Payable to ISD 621) are accepted. Tuition payment options and monthly payment coupons are available at the September Orientation. Tuition fee waivers may be granted under extreme circumstances. Contact the Play and Learn Preschool office ( ) for more information.. Proof of income must accompany the registration form. Proof of Income: W-2 Form Pay Stub Line 37 from last year s Tax form 1040 Formula for determining monthly tuition amount: Total household size: Total annual income: = Monthly Fee Gross Annual Income Tuition Scale for Two (2) Day Per Week Class Household size $36,500 Free Free Free Free Free Free Free $36,501 - $44,500 $10 $10 Free Free Free Free Free $44,501 - $51,500 $20 $20 $20 Free Free Free Free $51,501 - $59,500 $30 $30 $30 $30 Free Free Free Gross Annual Income Tuition Scale for Three (3) Day Per Week Class Household size $36,500 Free Free Free Free Free Free Free $36,501 - $44,500 $20 $20 Free Free Free Free Free $44,501 - $51,500 $40 $40 $40 Free Free Free Free $51,501 - $59,500 $60 $60 $60 $60 Free Free Free Gross Annual Income Tuition Scale for Five (5) Day Per Week Class Household size $36,500 Free Free Free Free Free Free Free $36,501 - $44,500 $30 $30 Free Free Free Free Free $44,501 - $51,500 $50 $50 $50 Free Free Free Free $51,501 - $59,500 $70 $70 $70 $70 Free Free Free

6 Play and Learn Preschool Eligibility Form Child s Name Date of Birth: Form Completed By: Relationship to Child: Nickname for Child: I would like my child to learn to write his/her name as: Food Restrictions: Who is the primary caregiver in helping to raise the child? Check all that apply. Mother Father Grandparent Foster Parent Other Employment Status: Parent One: Employed Full-time Employed Part-time Unemployed Parent Two: Employed Full-time Employed Part-time Unemployed How many people live in your household? Adults Children Does your family participate in any of these programs? Check all that apply. Child Care Assistance Food Shelf WIC MFIP Please check all that have occurred in the last year: Moved to a new residence Family has moved two or more times in the past year Family is homeless Chronic illness of a family member Death of a parent Chemical issues New brother or sister Parent has lost their job Parents have divorced Single Parent Household Family has experienced abuse, neglect or family violence Other issues Prenatal Care Check all the apply Premature birth: What month (Circle) fifth, sixth, seventh, eighth High risk in pregnancy or at birth Child exposed prenatally to alcohol, tobacco, drugs or stress Over

7 What is your child s race: Asian Hispanic/Latino Black/African/African American White Native American Does your child speak English fluently? Yes No If no, what is your home language? Does your child understand English? Yes No A little Has your child ever attended preschool? Yes No Has your child completed Early Childhood Screening? Yes No Has your child s development been on schedule? Yes No Do you have any concerns about your child s development? Yes No Describe your concerns; The Play and Learn Preschool Program wants your child to have a terrific school experience, and the best way for this to happen is for your child to regularly attend school. With consistent attendance, you will be amazed at the progress your child will make throughout the school year. I certify that all the information on this application is true and correct. I understand that the administrative office may verify the information on this application at any time. Signature of Parent/Guardian Date

8 Health & Emergency Record Complete this form and turn in with Play and Learn Preschool applicaton forms. Attach the child s Immunization Record or your clinic can fax the record to us at Thank you. Child First, Last Name Birth Date Gender Class Name and # Home Address City Zip Circle School: Pike Lake Education Center or Snail Lake Education Center Parent First & Last Name Phone Parent First & Last Name Phone IN CASE OF EMERGENCY Provide the name of a contact who can care for your child in case the parent cannot be reached. Contact First & Last Name Relationship to Child Phone Daycare Provider Name Phone Describe any current or continuing health conditions. List any medications the child takes regularly. List allergies: List food restrictions: Child s Physician/Clinic Phone Child s Dentist Phone PHOTO PUBLICATION PERMISSION I give permission for Mounds View Schools to use unidentified photos or videos of my child and/or myself for use in the classroom, for publication or for posting to the school district website to publicize Early Childhood Education. YES NO Parent Signature Date NOTE: In the event of life-threatening illness or injury and when a parent or emergency contact cannot be reached will be called to respond and make recommendations for the child s care.

9 Must be on file before a child attends any early childhood programs* Name Birthdate Early Childhood Immunization Form Date of Enrollment Minnesota law requires children enrolled in early education programs to be immunized against certain diseases or file a legal medical or conscientious exemption. Parent/Guardian: You may attach a copy of the child s immunization history to Type of Vaccine DO NOT USE ( ) or ( ) *Early childhood programs are defined as programs that provide instructional or other services to support children s learning and development and: Serve children from birth to kindergarten. Meet at least once a week for at least six weeks or more during the year. This includes but not limited to early childhood family education (ECFE), early childhood special education (ECSE), school readiness programs, and other public and private preschool and pre-kindergarten programs. this form OR enter the MONTH, DAY, and YEAR for all vaccines your child received. Enter MED to indicate vaccines that are medically contraindicated including a history of disease, or laboratory evidence of immunity and CO for vaccines that are contrary to parent or guardian s conscientiously held beliefs. Sign or obtain appropriate signatures on reverse. Complete section 1A or 1B to certify immunization status and section 2A to document medical exemptions (including a history of varicella disease) and 2B to document a conscientious exemption. Additionally, if a parent or guardian would like to give permission to the early education program to share their child s immunization record with Minnesota s immunization information system, they may sign section 3 (optional). For updated copies of your child s immunization history, talk to your doctor or call the Minnesota Immunization Information Connection (MIIC) at or st Dose Mo/Day/Yr 2nd Dose Mo/Day/Yr 3rd Dose Mo/Day/Yr 4th Dose Mo/Day/Yr 5th Dose Mo/Day/Yr Required (The shaded boxes indicate doses that are not routinely given; however, if your child has received them, please write the date in the shaded box.) Diphtheria, Tetanus, and Pertussis (DTaP, DTP) 3 doses during 1st year (at 2-month intervals) 4 th dose at months 5 th dose at 4-6 years Indicate vaccine type: DTaP or DTP Polio (IPV, OPV) 2 doses in the first year 3 rd dose by 18 months 4 th dose at 4-6 years Measles, Mumps, and Rubella (MMR) Required for children 15 months and older 1 st dose on or after 1 st birthday 2 nd dose at 4-6 years Haemophilus influenzae type b (Hib) 2-3 doses in the first year 1 dose required after 12 months or older For unvaccinated children months, 1 dose is required Not required for children 5 years or older Varicella (chickenpox) Required for children 15 months and older 1 st dose on or after 1 st birthday 2 nd dose at 4-6 years Pneumococcal Conjugate Vaccine (PCV) Required for children age 2-24 months 3 doses in the first year 4 th dose after 12 months At least 1 dose is recommended for children age months in child care Hepatitis B (hep B) 2-3 doses in the first year 3rd dose (final dose) by 18 months Hepatitis A (hep A) 2 doses separated by 6 months for children 12 months and older Recommended Rotavirus (2-3 doses between 2 and 6 months) Influenza (annually for children 6 months or older) 4th dose not required if 3rd dose was given on or after the 4th birthday 5th dose not required if 4th dose was given on or after the 4th birthday Developed by the Minnesota Department of Health - Immunization Program (12/13)

10 Name Instructions, please complete: Box 1 to certify the child s immunization status Box 2 to file an exemption (medical or concientious) Box 3 to provide consent to share immunization information (optional) 1. Certify Immunization Status. Complete A or B to indicate child s immunization status. A. Children who are 15 months or older: For children who are 15 months or older and who have received all the immunizations required by law for early childhood programs: I certify that the above-named child is at least 15 months of age and has completed the immunizations which are required by law for child care. B. Children who are younger than 15 months: For children who are younger than 15 months OR have not received all required immunizations: I certify that the above-named child has received the immunizations indicated. In order to remain enrolled this child must receive all required vaccines within 18 months from initial enrollment date. The dates on which the remaining doses are to be given are: Signature of Parent / Guardian OR Physician / Nurse Practitioner / Physician Assistant / Public Clinic Date Signature of Physician / Nurse Practitioner / Physician Assistant / Public Clinic Date 2. Exemptions to Immunization Law. Complete A and/or B to indicate type of exemption. A. Medical exemption: No child is required to receive an immunization if they have a medical contraindication, history of disease, or laboratory evidence of immunity. For a child to receive a medical exemption, a physician, nurse practitioner, or physician assistant must sign this statement: I certify the immunization(s) listed below are contraindicated for medical reasons, laboratory evidence of immunity, or that adequate immunity exists due to a history of disease that was laboratory confirmed (for varicella disease see * below). List exempted immunization(s): B. Conscientious exemption: No child is required to have an immunization that is contrary to the conscientiously held beliefs of his/her parent or guardian. However, not following vaccine recommendations may endanger the health or life of the child or others they come in contact with. In a disease outbreak, children who are not vaccinated may be excluded in order to protect them and others. To receive an exemption to vaccination, a parent or legal guardian must complete and sign the following statement and have it notarized: I certify by notarization that it is contrary to my conscientiously held beliefs for my child to receive the following vaccine(s): Signature of physician/nurse practitioner/physician assistant Date *History of varicella disease only. In the case of varicella disease, it was medically diagnosed or adequately described to me by the parent to indicate past varicella infection in (year) Signature of parent or legal guardian Date Subscribed and sworn to before me this: day of 20 Signature of physician/nurse practitioner/physician assistant (If disease occured before September 2010, a parent can sign.) Signature of notary (A copy of the notarized statement will be forwarded to the commissioner of health.) 3. Parental/Guardian Consent to Share Immunization Information (optional): Your child s early childhood program is asking your permission to share your child s immunization documentation with MIIC, Minnesota s immunization information system, to help better protect children from disease and allow easier access for you to retrieve your child s immunization record. You are not required to sign this consent; it is voluntary. In addition, all the information you provide is legally classified as private data and can only be released to those legally authorized to receive it under Minnesota law. I agree to allow early childhood program personnel to share my child s immunization documentation with Minnesota s immunization information system: Signature of parent or legal guardian Date Developed by the Minnesota Department of Health - Immunization Program (12/13)

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