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 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)
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.
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.
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