Enrollment packet

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Post on 24-Jan-2015



Self Improvement

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<ul><li> 1. Authorization and Permission Form for _______________________ (childs name)I/We _____________________________________________, hereby grant permission to Yasmeen Nasira of Yasmeens BrightSteps Academy to provide the following activities for our child by initialing &amp; signing below.1.I/We hereby grant permission for our child to use all of the indoor and outdoor play equipment and to participate in all of the activities of this childcare home. ______2. I/We hereby grant permission for our child to sleep in a nap room on a bed, playpen, mat or cot provided. ______3. I/We hereby give permission for our child to leave the childcare premises under the supervision of a responsible adult for neighborhood walks and other scheduled and unscheduled excursions. Permission forms for each trip are not required. ______4. I/We understand that all field trip expenses are the parents responsibility and agree to this as it is stated in the policy statement of this child care home. I/We also understand that if a field trip will take place that the provider will give advance notice and a separate permission form to be signed with the details of the trip. I also understand that if I choose for my child not to attend, that it is my responsibility to find alternate care for that day without childcare reimbursement from the provider for the fieldtrip. ______5. I/We give permission for our child to have sunscreen applied on exposed skin areas before going outside on sunny days. Sunscreen is supplied by the parent/provider and applied per stated in the health policies handbook. ______6. I/We give permission for over the counter products and topical to be used on our child for preventative purposes including but not limited to skin lotion, diaper cream/ointments, Orajel, Neosporin, Chapstick, or ___________ and ______________.7. I/We GIVE/DO NOT GIVE (circle one) permission to introduce new foods to my child before the age of 12 months. Parents will keep the provider informed of the foods being introduced. ______8. I/We give permission to work on potty-training my child once they are determined ready for this process. I understand that a child seat will be used on a regular toilet if needed. ______ 11. Initial to Initial to I/We give permission for my child to participate in each of the following activities for no ApproveDeny more than 2 hours each day. All media programs contain age-appropriate content (G or PG ratings) and will not contain violence, profanity or other inappropriate content. A Television B Video C Gaming systems D Computer E Music &amp; Movement F Telephone (real) for the purpose of:I/We _______________________________________________, authorize Yasmeen Nasira of Yasmeens Bright Steps Academyto call a doctor, 911, or an ambulance for medical or surgical care for my/our child __________________________________(childs name), should an emergency arise. It is understood that a conscientious effort will be made to locate theparents/guardians before emergency action will be taken, but if this is not possible, the expenses of emergency medicaltreatment or care will be accepted by the parents/guardians. Notarization is required annually to provide the childcareprovider with authorization to give medical authorization to emergency/health professionals:_______________________________________ _____________________Parent/Guardian Date_______________________________________ _____________________Parent/Guardian DateSubscribed and affirmed before me this ____________ day of ___________,20__, in the County of__________________________, State of Colorado.______________________________________Notary PublicMy Commission Expires: _____________________________</li></ul> <p> 2. Child Release AuthorizationI understand that every effort will be made to contact me. In the event the provider is unable to reach me I authorizethe following designate(s) to pick up my child. I understand designate(s) must be over the age of 18 years and have avalid state issued drivers license and an age appropriate vehicle child restraint. I will instruct my designate(s) tobring their I.D. with them each time they are needed to pick up my child. I also understand that any additions to myChild Release form must be done in writing prior to needing a new addition to pick my child up. I understandwithout written consent the provider cannot release my child to another person not listed.Childs name: ________________________________________ DOB: _________________________The following persons are authorized to pick up my child:1st PersonName: Relationship:Address:Work/Home Phone:City/Zip: Alternate Contact:2nd PersonName: Relationship:Address:Work/Home Phone:City/Zip: Alternate Contact:3rd PersonName: Relationship:Address:Work/Home Phone:City/Zip: Alternate Contact:4th PersonName: Relationship:Address:Work/Home Phone:City/Zip: Alternate Contact:5th PersonName: Relationship:Address:Work/Home Phone:City/Zip: Alternate Contact:_________________________________ _______________________________Parent/Guardian signature Date_________________________________ _______________________________Parent/Guardian signature Date 3. PERMISSION TO PHOTOGRAPH FORMI, ________________________________________________________________________________________(parents or guardians name)give permission for Yasmeens Bright Steps Academyto photograph my child/ren, _____________________________________________________________(childs name)for the following purposes: (Please check one) Type of Use: Grant PermissionDecline PermissionStill Photographs:Display in providers personal scrapbookGive photographs to current clientsDisplay in facilitys scrapbook or bulletinboards, shown to current andprospective clientsDisplay still photos on facilitys website *Use still photos in promotional materialsVideos:Give video to current parentsDisplay video on facility websiteUse videos in promotional materialsOther (please list):* only first names and possibly last initials (in the event of two or more children with the same firstname) will be displayed on the facility website.I understand that it is my responsibility to update this form in the event that I no longer wish toauthorize one or more of the above uses. I agree that this form will remain in effect during theterm of my childs enrollment. By signing below, I also agree that this is a legally binding form,and providing false information could be grounds for termination of preschool services, forfeitureof retainer, or both.Father/Guardians SignatureDateMother/Guardians SignatureDateYasmeens Bright Steps Academy Date 4. School Transportation Release__ Check if Non Applicable to this child__ Check if child walks to a bus stop__ Check if School provides bus serviceChilds Name: ______________________________ Days Transportation Needed: M T W R FSchool Drop Off Time: ______________ School Pick Up Time: ______________Name &amp; Address of School: _______________________________________________________School Telephone #: ____________________ Teachers Name: ____________________Grade: __________ Track: _______________ Bus Stop Location:________________________________________Before School Activity: ______________________ Day(s) Transportation Needed: M T W R FResponsible Adult &amp; Phone: _____________________________ Drop Off Time: ____________After School Activity: _______________________ Day(s) Transportation Needed: M T W R FResponsible Adult &amp; Phone: _____________________________ Drop Off Time: ____________ I/we _____________________________________ have/have not requested my childcare provider transport my child to school/preschool. I/we give/do not give permission to the provider to allow my child to walk to the bus stop by themselves or with other school-age children from the child care home, if any. I/we understand it is my responsibility as the parent, to notify my childcare provider in advance and in writing of any changes in the school transportation schedule. I/we understand that it is my responsibility to provide the childcare provider a school calendar prior to the start of school each year. I/we understand that is my responsibility as a parent, to notify my childcare provider immediately in the event the school sends my child home ill. I/we, the undersigned parent(s) / guardian(s), do understand that school transportation is provided as a special service. I/we will not hold our childcare provider responsible for any problem that may arise due to weather, mechanical problems with the child care vehicle, scheduling conflicts, etc. If child is tardy from expected arrival time to the child care providers home, the provider will contact the parent or guardian. The Parent or Guardian is responsible to find the whereabouts of their child._____________________________________________________________________Parent/Guardian Parent/Guardian_____________________________________________________________________DateDate </p>


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