E arly C hildhood E ducation
|
|
|
- Osborn Greer
- 9 years ago
- Views:
Transcription
1 Child's Last Name, First Name: Grade: The Seven Hills School E arly C hildhood E ducation State Mandated Documentation
2 Instructions and Forms Dear Parents: Enclosed you will find the paperwork required by the state for Preschool, Prekindergarten and Kindergarten. Please: For each child, please fill out, sign and return to the school along with your contract. (We suggest you make a copy prior to signing, as this packet is required each year.) The ECE Packet must be returned with your child s enrollment contract. The form entitled Physician s Report- Child s Pre-Admission Health Evaluation (LIC701) will need to be completed by your child s physician and returned to the school as soon as possible. The State requires immunization records and the ECE Forms before a student enters the classroom. There are no exceptions to this requirement. If we do not have your child's immunization records and physician's forms by the first day of school, we will ask you to keep your child at home until the records are turned in to the school. The following lists the ECE packet documents. Please complete and return the entire packet with the exception of the Caregiver Background Check information. ECE Packet Admission Agreement (3 pages) LIC 613A (8/08) Personal Rights LIC 995 (9/08) Notification of Parents Rights LIC 995E (4/99) Important Information for Parents Caregiver Background Check As well as medical forms: LIC 701 (8/01) Physician s Form Pre-Admission Health Evaluation LIC 702 (7/99) Child s Preadmission Health History Parent s Report Oral Health Notification Letter and Oral Health Assessment (4 pages total)
3 ADMISSION AGREEMENT The Early Childhood Programs at Seven Hills School are licensed by the state Department of Social Services, Community Care Licensing Division. They require that the following information is made available to you. State regulations require that you sign and return this form to the Seven Hills School. A. Basic Services The school (center) shall provide the following basic services for Name of Child Being Enrolled Birth date Parent of Guardian of Child Being Enrolled Relationship to Child 1. See attached fee schedules. 2. The child shall be furnished a midmorning snack consisting of at least two items from two of the four basic food groups. Such a snack shall also be furnished mid afternoon for children who are at school after 3:30 P.M. 3. The child shall be given assistance with personal care as needed. 4. The child shall be provided with an opportunity to nap between 1:00 P.M. and 3:00 P.M. on a cot or mat provided by the school. (Preschool and Junior K.) 5. The child shall be placed in a group of peers based on age and/or special needs as determined by the staff. 6. The child shall be involved in a program of play and learning experiences which are appropriate for the ages of the children enrolled in the school. A balance of active and quiet play is provided for with individual and group activities which are geared toward the emotional, social, physical, aesthetic and individual growth of young children. 7. The school shall assume responsibility for the child after the child has passed the legally required morning health inspection and has been signed in by a parent, guardian or designated representative of the child's parents or guardians. The school shall retain responsibility until the child is signed out by a parent, guardian or designated representative of the child's parents or guardians. 8. The child shall be administered physician-prescribed medication only upon the written request of the child's parents or guardians. The school shall not administer a non-prescription medication unless it is accompanied by a physician's request to do so. The school shall have no responsibility whatsoever for failure to provide requested prescription medication nor for adverse reactions which are caused by the administration of such prescription medication. 9. The school shall give appropriate first aid to a hurt child. A parent or guardian shall be contacted if it is the judgment of the school staff that immediate medical attention is necessary. If it is further the judgment of the school staff that the injury is of an emergency nature, paramedics shall be called to the school and a parent or guardian shall be contacted. 10. An ill child shall be isolated and given appropriate care until called for by a parent, guardian or a designated representative. 11. The school shall notify the child's parents or guardians of a suspected exposure to a communicable disease. 12. The school shall make every effort to safeguard personal belongings brought by the child but shall not be responsible for lost or broken items. B. For payment provisions see attached fee schedule and contract.
4 C. Requirements for Acceptance into the ECE Program: 1. Generally, your child must be three (3) years of age by September 1 st for acceptance into Rainbow Preschool. If an exception is made and your child is accepted at two (2) years nine (9) months or older, he/she will spend two (2) years in Rainbow Preschool. 2. Your child must be four (4) by September 1 st for acceptance into Prekindergarten. 3. Your child must be five (5) by September 1 st for acceptance into Kindergarten. 4. Your child must be potty trained on the first day of school. Your child is considered potty trained if he/she has no more than three (3) accidents within a thirty (30) day period. 5. In the event that your child has a bowel movement in his/her clothes during school, a parent or another adult authorized by the parent must come to the school to change the child. D. Obligations of parents or guardians. 1. A parent or guardian shall furnish requested medical information and any forms required by the state before the child may attend school. 2. A parent, guardian or designated representative of the child's parents or guardians shall bring the child to the school building upon arrival, wait for a health inspection and then sign in on the appropriate register. 3. A parent, guardian or designated representative of the child's parents or guardians shall sign the child out on the appropriate register before taking the child from the premises. 4. The parents or guardians shall notify the school when someone other than those named on the emergency information card will be calling for the child. 5. The parents or guardians shall provide the child with a nutritious lunch if the child is to be at school after 12: 00 noon. 6. The parents or guardians shall provide the child with a blanket or other covering to use during nap periods if the child stays at school after 1:00 P.M. 7. The parents or guardians shall see that the child is dressed appropriately when brought to school. 8. The parents or guardians shall notify the school of the child's possible exposure to a communicable disease. 9. The parents or guardians shall notify the school when the child is absent. 10. The parents or guardians shall abide by the parking rules of the school. 11. The parents or guardians shall notify the school when the child will not be called for at the time so specified when signing in. E. Termination of the Agreement: This Agreement shall be terminated if any one or more of the following occur: 1. The school year has come to an end. 2. Death of the child. 3. Serious illness of the child preventing school attendance. 4. The parents or guardians of the child allow their account to become delinquent. 5. Failure of the parents or guardians to honor the obligations listed in this Agreement or in any rules, regulations or manuals promulgated or provided by the school.
5 6. The school in its sole and unfettered discretion determines that it is unable to meet the needs of the child. 7. The school in its sole and unfettered discretion determines that it is not in the best interest of the school or other children enrolled at the school to have the child in attendance. 8. Failure of the child's parents or guardians to cooperate with the school in a manner in which the school determines in its sole and unfettered discretion is serious enough to warrant termination. Procedure: In exercising its discretion under numbers 5,6,7 and 8 above the school may require the child and/or the child's parents or guardians to attend conference(s) with school personnel regarding the matters that potentially warrant termination of the Agreement. The child's parents or guardians may request a conference with school personnel regarding the matters that potentially warrant termination but the school shall have no obligation to grant any such request. The school's director or staff shall have the sole right and responsibility to determine any disputed factual matters regarding termination of this Agreement. F. Modification Clause: This Agreement may be modified whenever any of the circumstances covered by this Agreement changes. Such modifications may only be made in writing and must be signed and dated by the parties involved in order to be binding and effective. Oral modifications are not binding under this Agreement and shall not be enforceable under any condition. G. Other: This provides that the parties to this Agreement are aware of the Department of Social Services right to interview the child and the school staff and to inspect and audit all records maintained by the school without securing the prior consent of anyone. The parties are also aware of the licensing agency's right to observe the physical condition of the child, including conditions indicting abuse or neglect, and to have a licensed medical professional physically examine the child. I agree to cooperate with the general policies of the school, to perform the obligations of parents or guardians set forth in the Agreement, and to abide by the rules, regulation, and manual promulgated and provided by the school. My signature below indicates that I have read the terms of this Agreement and that I have read the rules, regulations and manuals promulgated and provided by the school. Parent or Guardian Parent or Guardian Director
2015-2016 APPLICATION PACKET
2015-2016 APPLICATION PACKET Child s Name: Last Name First Name Middle Enrollment Procedure The parents and child will visit Palm Valley Montessori School for an interview with the director and/or administrator,
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)
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...
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
Registration Form. Full Name. Address. Phone Numbers (H)
Registration Form Parent Information Parent 1 Full Name Address Phone Numbers (H) (C) (W) E-mail Address *Would you like to receive e-mails to this email address about special promotions/events at The
HIPAA Notice of Privacy Practices
HIPAA Notice of Privacy Practices Date of Last Revision: 09/20/2013 Effective Date: Immediately THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
EARLY CHILDHOOD EDUCATION CENTER ENROLLMENT FORM
EARLY CHILDHOOD EDUCATION CENTER ENROLLMENT FORM 55 PA CODE CHAPTERS 3270 123 & 181 (C): 3280 123 & 181 (C): 3290 123 & 181 (C) CHILD S FIRST NAME MIDDLE NAME LAST NAME BIRTH DATE START DATE WITHDRAWAL
HEALTH REQUIREMENTS & SERVICES: MEDICAL TREATMENT
DESCRIPTOR TERM: Students Millard District Policy File Code: 6200 1 st Reading: 05-08-14 HEALTH REQUIREMENTS & SERVICES: MEDICAL TREATMENT Purpose The purpose of this policy is to authorize school personnel
Special Education For Preschoolers
C A L I F O R N I A E A R L Y S T A R T Special Education For Preschoolers A G U I D E F O R P A R E N T S Early Intervention services system encouraging partnerships between families and professionals,
NOTICE OF PRIVACY PRACTICES
NOTICE OF PRIVACY PRACTICES Effective 5/1/04; Revised 1/1/15 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
Harris County - Texas HIPAA Notice of Privacy Practices
Harris County - Texas HIPAA Notice of Privacy Practices Effective Date: September 23, 2013. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
Georgia Tech North Ave. NW Atlanta Ga. 30332
Welcome to Fun Weird STEM Saturdays 2014 The functioning objective of Fun Weird Science STEM Saturdays is to: 1. Provide students with hands-on STEM experience; and 2. Engage students in the exciting ways
THE NEWARK PUBLIC SCHOOLS Newark, New Jersey POLICY
THE NEWARK PUBLIC SCHOOLS Newark, New Jersey POLICY FILE CODE: 5113 (Page 1 of 6) ABSENCES AND EXCUSES In order for the Newark Public Schools to fulfill its responsibility for providing a thorough and
Meadows Christian Learning Center Statement of Policies and Procedures
Meadows Christian Learning Center Statement of Policies and Procedures Welcome to Meadows Christian Learning Center! This is a list of our Center s operational policies and procedures. Please read them
CHILD CARE LICENSING REGULATION
Province of Alberta CHILD CARE LICENSING ACT CHILD CARE LICENSING REGULATION Alberta Regulation 143/2008 With amendments up to and including Alberta Regulation 62/2013 Office Consolidation Published by
Information with a person who is involved in your medical care or payment for your care, such as your family or a
Notice of Privacy Practices Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
Notice of Privacy Practices. Human Resources Division Employees Benefits Section
Notice of Privacy Practices Human Resources Division Employees Benefits Section THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
NOTICE OF PRIVACY PRACTICES
NOTICE OF PRIVACY PRACTICES In 1996, the U.S. Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Among others, the Act applies to health care providers and hospitals; it is
This Notice describes Hill-Rom s practices regarding the use of your Protected Health Information, specifically including:
Original Effective Date: April 1, 2003 Effective Date of Last Revision: July 15, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
HIPAA Omnibus Notice of Privacy Practices Effective Date: March 03, 2012 Revised on: July 1, 2015
HIPAA Omnibus Notice of Privacy Practices Effective Date: March 03, 2012 Revised on: July 1, 2015 Mobile Physician Group PC 231 High Street Suite 1, Mount Holly, NJ 08060 1-855-MPG-DOCS THIS NOTICE DESCRIBES
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
2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION
These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we
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
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR IF YOU NEED MORE INFORMATION, PLEASE CONTACT OUR PRIVACY OFFICER:
NOTICE OF PRIVACY PRACTICES COMPLETE EYE CARE THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
HIPAA Notice of Privacy Practices Effective Date: 09/23/13
HIPAA Notice of Privacy Practices Effective Date: 09/23/13 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
NOTICE OF PRIVACY PRACTICES
Page 1 of 6 NOTICE OF PRIVACY PRACTICES Revised: June 15, 2014 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
SOUTHLAKE DERMATOLOGY 1170 N. Carroll Ave. Southlake, TX 76092 www.southlakedermatology.com Main 817-251-6500 Fax 817-442-0550
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. EFFECTIVE September 15, 2014 This Notice of
GONZABA MEDICAL GROUP PATIENT REGISTRATION FORM
GONZABA MEDICAL GROUP PATIENT REGISTRATION FORM DATE: CHART#: GUARANTOR INFORMATION LAST NAME: FIRST NAME: MI: ADDRESS: HOME PHONE: ADDRESS: CITY/STATE: ZIP CODE: **************************************************************************************
Northwest Cardiology Associates 400 W. Northwest Hwy Barrington, IL 60010 847.382.4600 Fax 847.382.1771. HIPAA Notice of Privacy Practices ( Notice )
Northwest Cardiology Associates 400 W. Northwest Hwy Barrington, IL 60010 847.382.4600 Fax 847.382.1771 HIPAA Notice of Privacy Practices ( Notice ) THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY
AGREEMENT FOR ADMISSION TO SANCTUARY CENTERS OF SANTA BARBARA RESIDENTIAL TREATMENT PROGRAM
AGREEMENT FOR ADMISSION TO SANCTUARY CENTERS OF SANTA BARBARA RESIDENTIAL TREATMENT PROGRAM 1. ( resident ), an individual, is admitted to Sanctuary Centers of Santa Barbara, Inc., (a California non-profit
Mesa Public Schools 63 E. Main Street Mesa, Arizona 85201
1 Mesa Public Schools 63 E. Main Street Mesa, Arizona 85201 Superintendent Dr. Debra Duvall Assistant Superintendent of Student Services Dr. David Shuff Special Education Department William Santiago Director
8 th Grade Event Packet Contents
8 th Grade Event Packet Contents 1) Letter Home About Upcoming Events and Donations please read and mark the appropriate box at the bottom of the page 2) Interested in Chaperoning? check the box and include
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
WELCOME TO THE AFFTON EARLY CHILDHOOD CENTER!
WELCOME TO THE AFFTON EARLY CHILDHOOD CENTER! Dear Families: I would like to welcome you to the Affton Early Childhood Center. I am excited that you have enrolled your child in our preschool program and
SCHOOL DISTRICT OF BLACK RIVER FALLS HIPAA PRIVACY AND SECURITY POLICY
SCHOOL DISTRICT OF BLACK RIVER FALLS HIPAA PRIVACY AND SECURITY POLICY School Board Policy 523.5 The School District of Black River Falls ( District ) is committed to compliance with the health information
NOTICE OF PRIVACY PRACTICES FOR OUR PATIENTS POTOMAC PHYSICIAN ASSOCIATES, P.C.
NOTICE OF PRIVACY PRACTICES FOR OUR PATIENTS POTOMAC PHYSICIAN ASSOCIATES, P.C. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Debbie Beach, LCSW [email protected] 202-415-6242
Debbie Beach, LCSW [email protected] 202-415-6242 COLLABORATIVE ENGAGEMENT AGREEMENT DIVORCE COACH Debbie Beach, LCSW 405 N. Washington St, #104 Falls Church, VA 22046 Date: Name of party: Dear Party:
HIPAA PRIVACY NOTICE PLEASE REVIEW IT CAREFULLY
HIPAA PRIVACY NOTICE THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. INTRODUCTION PLEASE REVIEW IT CAREFULLY Moriarty
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 [email protected]
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:
Application for Childcare
261 Sky River Parkway Monroe, WA 98272 Tel: (360) 794 4775 DSHS Provider #: 827175 Application for Childcare Child s Name: Grade (current/going into): School: Please indicate which program you will be
ABA INTAKE FORM CHILD INFORMATION. Today s Date: / / Child s name: DOB: Address: City: State: Zip Phone:
Today s Date: / / ABA INTAKE FORM CHILD INFORMATION Child s name: DOB: Address: City: State: Zip Phone: FAMILY INFORMATION Mother s/guardian s name: Work #: Occupation: Address (if different from client):
MODEL POLICY REPORTING CHILD ABUSE AND NEGLECT FOR SCHOOL OFFICIALS IN DUPAGE COUNTY
MODEL POLICY REPORTING CHILD ABUSE AND NEGLECT FOR SCHOOL OFFICIALS IN DUPAGE COUNTY The DuPage County State s Attorney s Office, the DuPage Regional Superintendent of Schools, the School District, the
MANOR HILLS, INC. ASSISTED LIVING RESIDENCE WITH SNALR 4192-B BOLIVAR ROAD WELLSVILLE, NY 14895 ADMISSION AGREEMENT
MANOR HILLS, INC. ASSISTED LIVING RESIDENCE WITH SNALR 4192-B BOLIVAR ROAD WELLSVILLE, NY 14895 ADMISSION AGREEMENT BETWEEN: The operator of Manor Hills Inc., Assisted Living Residence and RESIDENT: RESPONSIBLE
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
MULTICARE ASSOCIATES OF THE TWIN CITIES, P.A. NOTICE OF PRIVACY PRACTICES
MULTICARE ASSOCIATES OF THE TWIN CITIES, P.A. NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
35145 Oak Glen Rd. Yucaipa, CA 92399 T: 909.790.0557
Thursday, April 17, 2014 RE: Welcome to Wildwood Christian Academy!! Dear Prospective Family, I would like to thank you for your interest in enrolling your student(s) at Wildwood Christian Academy. It
Esther Aloia. Brentwood High School Preschool Program 3601 Brownsville Road Pittsburgh, PA 15227 PROGRAM
Brentwood High School Preschool Program 3601 Brownsville Road Pittsburgh, PA 15227 PROGRAM It is the philosophy of the Brentwood High School Preschool focuses on early childhood as an important time in
NOTICE OF PRIVACY PRACTICES
Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. OUR PLEDGE
Wyoming School Boards Association Insurance Trust ( The Plan ) HEALTH CARE PLAN PRIVACY NOTICE
Wyoming School Boards Association Insurance Trust ( The Plan ) HEALTH CARE PLAN PRIVACY NOTICE THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
Welcome To Our Physical Therapy Department
Welcome To Our Physical Therapy Department Our entire staff is dedicated to providing our patients with the best possible care and service while keeping the costs to you from increasing at an unreasonable
CENTRAL MAINE CHRISTIAN ACADEMY 390 Main Street Lewiston, Maine 04240 207.777.0007 www.centralmainechristianacademy.org
CENTRAL MAINE CHRISTIAN ACADEMY 390 Main Street Lewiston, Maine 04240 207.777.0007 www.centralmainechristianacademy.org REGISTRATION FORM (Please Print) STUDENT INFORMATION Student s last name: First:
HIPAA NOTICE OF PRIVACY PRACTICES
HIPAA NOTICE OF PRIVACY PRACTICES Human Resources Department 16000 N. Civic Center Plaza Surprise, AZ 85374 Ph: 623-222-3532 // Fax: 623-222-3501 TTY: 623-222-1002 Purpose of This Notice This Notice describes
NOTICE OF PRIVACY PRACTICES UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM
NOTICE OF PRIVACY PRACTICES Effective Date: April 14, 2003 UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
HIPAA Notice of Privacy Practices - Sample Notice. Disclaimer: Template Notice of Privacy Practices (45 C.F.R. 164.520)
HIPAA Notice of Privacy Practices - Sample Notice Disclaimer: Template Notice of Privacy Practices (45 C.F.R. 164.520) The information provided in this document does not constitute, and is no substitute
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
Enrolment & Orintation
Paddington Out Of School Care Enrolment & Orintation POLICY STATEMENT: Our service accepts enrolments to the service for primary school age children in accordance with funding priorities and guidelines.
GREETINGS FROM THE VERDE VALLEY SCHOOL HEALTH CENTER
GREETINGS FROM THE VERDE VALLEY SCHOOL HEALTH CENTER Dear Parent, Verde Valley School is committed to providing your child with the best possible care. It is with this goal in mind that the school requires
Child Care Regulations in Nevada
Child Care Regulations in Nevada Overview A summary of child care regulations in Nevada. Types of care that must be licensed Types of care that may operate without a license Subsidized child care Whom
Kansas Statutes for School Health Services
Kansas Statutes for School Health Services Dental Screening 72-5201. Annual free dental inspection; exceptions. The boards of education of cities of the first and second class and school boards of school
Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC
Registration Packet Summer Academy June 3 rd to August 30 th Z M G www.zmgtennis.com HP and TTT Registration Form 1, LLC Enrolment Process prides its self on offering everything essential in the development
HIPAA HITECH PA Physician Practices
NOTICE OF PRIVACY PRACTICES Premier Urology Associates LLC dba Urology Care Alliance SUMMARY Effective Date: 12/20/2012 WHAT IS THIS NOTICE FOR? This Notice of Privacy Practices (Notice) describes how
We appreciate your interest in the Child Development Center and look forward to your family joining our family.
Dear Parent: We appreciate your interest in the Child Development Center and look forward to your family joining our family. Our application packet is attached. Please remove the "Child's Medical Report"
CHILD ABUSE. Administrative Procedure 325 300-37. Background
300-37 Administrative Procedure 325 CHILD ABUSE Background The District requires all staff to concern themselves with the physical, social and emotional welfare of each student. Abuse or neglect of children
Notice of Privacy Practices for Protected Health Information (PHI)
Notice of Privacy Practices for Protected Health Information (PHI) Arapahoe Sports Medicine and Rehabilitation THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
155 McDonald Drive SW Shirley E. Charette, MS, PA-C
LAKELAND FAMILY MEDICINE Dennis J. Charette, M.D. 155 McDonald Drive SW Shirley E. Charette, MS, PA-C Carri A. Meiler, MS, PA-C Phone: 330-308-8999 Fax: 330-308-8016 www.lakelandfamilymedicine.com PATIENT
HIPAA POLICIES & PROCEDURES AND ADMINISTRATIVE FORMS TABLE OF CONTENTS
HIPAA POLICIES & PROCEDURES AND ADMINISTRATIVE FORMS TABLE OF CONTENTS 1. HIPAA Privacy Policies & Procedures Overview (Policy & Procedure) 2. HIPAA Privacy Officer (Policy & Procedure) 3. Notice of Privacy
Community House High School Programs Standing with families since 1969
Dear Parents/Guardians, Founded in 1969, Community House is devoted to standing with Princeton families by providing tools for academic success and social- emotional wellness through programs that bolster
Dear Parents: Welcome and thank you for choosing Coastal Pediatrics! We appreciate the opportunity to provide your child with the highest quality
Dear Parents: Welcome and thank you for choosing Coastal Pediatrics! We appreciate the opportunity to provide your child with the highest quality pediatric care. Additionally, we promise to offer superior
If you are under 18 years of age, your parents or guardian must sign for you and handle your privacy rights for you.
HIPAA NOTICE OF PATIENT PRIVACY PRACTICES CWCC618 Exhibit A Effective Date: November 1, 2011 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
Greater Dallas Orthopaedics, PLLC. Notice of Privacy Practices
Notice of Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Uses and Disclosures
Eye Clinic of Bellevue, LTD. P.S. Privacy Policy EYE CLINIC OF BELLEVUE LTD PS NOTICE OF INFORMATION PRACTICES
Eye Clinic of Bellevue, LTD. P.S. Privacy Policy EYE CLINIC OF BELLEVUE LTD PS NOTICE OF INFORMATION PRACTICES Date of Last Revision: 4/8/03 Effective Date: Immediately This information is made available
Bulkley Valley Christian Preschool Parent Handbook 2015-2016
Bulkley Valley Christian Preschool Parent Handbook 2015-2016 We will tell the next generation the praise worthy deeds of the Lord, His power, and the wonders he has done. Psalm 78:4 Parent Handbook Welcome
FAIRFAX COUNTY PUBLIC SCHOOLS PROCEDURES REQUIRED FOR IMPLEMENTATION OF SPECIAL EDUCATION REGULATIONS IN VIRGINIA S PUBLIC SCHOOLS
FAIRFAX COUNTY PUBLIC SCHOOLS PROCEDURES REQUIRED FOR IMPLEMENTATION OF SPECIAL EDUCATION REGULATIONS IN VIRGINIA S PUBLIC SCHOOLS Table of Contents Child Find... 2 Screening... 3 General Screening Procedures...
Rules Regulating Child Care Centers
Rules Regulating Child Care Centers 7.702 RULES REGULATING CHILD CARE CENTERS (LESS THAN 24-HOUR CARE) All child care centers must comply with the "General Rules for Child Care Facilities" as well as the
Each Peach Childcare Terms and Conditions
Each Peach Childcare Terms and Conditions To enable EPC (as defined below), to provide and maintain the highest quality standards of childcare and the Services, it is necessary for all Parents/Guardians
Anxiety Treatment Center, LLC
Anxiety Treatment Center, LLC 6 Forest Park Drive, 2 nd Floor 860 269 7813 Patient Information Sheet Name: Address: Phone (h) : Phone (w) : Phone (c) : Email: DOB: Family Members (Name, Age, Gender, Relationship)
Texas & Louisiana Child Labor Resource Sheet
TEXAS TEXAS WORKFORCE COMMISSION Hours Requirements for Children Under 16 Texas & Louisiana Child Labor Resource Sheet www.twc.state.tx.us/ui/lablaw/texas-child-labor-law.html May not work more than: (1)
Notice of Health Information Privacy Practices Radiology Associates of Norwood, Inc.
Notice of Health Information Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE
