Classes and resources for parents and their infants, toddlers and preschoolers.

2012-2013

www.MoundsViewSchools.org651-621-7420651-621-7422

Preschool classes for children ages 3 to 5 years old as of September 1

2017-2018

Play and Learn

Preschool (formerly School Readiness Preschool)

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 2017-2018.

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. Confir-mation emails will be sent.

Bus TransportationPlay 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 attend-ing SLEC for preschool must reside in or attend daycare in the Island Lake or Turtle Lake school attendance area.

Snail Lake EducationCenter - SLEC350 Highway 96 WestShoreview 55126

Pike Lake Education Center - PLEC2101 14th St NWNew Brighton 55112

Children’s Learning

Play and Learn Preschool Locations

Sharon Savard, Play and Learn Preschool Supervisor 651-621-7422

sharon.savard@moundsviewschools.org

Parent Information NightsParents of children ages 3 - 5 years are invited to come see classrooms, meet teachers and hear about our preschool learning activities and parent educa-tion opportunities.

Pike Lake Education CenterApril 18 6:30-7:30 pm or April 20 6:30-7:30 pm Spanish interpreter

Pike Lake Education Center, New Brighton

Snail Lake Education Center, Shoreview

Play and Learn 3s For children 3 years old by September 1, 2017. 5050 T & TH AM PLEC 15051 T & TH AM PLEC 25052 M, W, F AM PLEC 1

Play and Learn 4s For children 4 years old by September 1, 2017. 5056 M, T, W, Th & F AM PLEC 45057 M, T, W, Th & F AM PLEC 3 5058 M, T, W, Th & F AM PLEC 405059 M, T, W, Th & F AM PLEC 44

Play and Learn 4s For children 4 years old by September 1, 2017. 5062 M, T, W, Th & F PM PLEC 35063 M, T, W, Th & F PM PLEC 405064 M, T, W, Th & F PM PLEC 44 5065 M, T, W, Th & F PM PLEC 1

Play and Learn 3s For children 3 years old by September 1, 2017. 5053 M, W & F AM SLEC 105

Play and Learn 4s For children 4 years old by September 1, 2017. 5060 M, T, W, Th & F AM SLEC 107

5067 M, T, W, Th & F PM SLEC 1055068 M, T, W, Th & F PM SLEC 107

Play and Learn PreschoolRegistration Form 2017-2018

Mail forms and payment to Pike Lake Education CenterPlay and Learn Preschool

2101 14th St NWNew Brighton, MN 55112

Child's First Name _________________________ Child's Last Name _________________________ Birthdate _________________Gender_________ Parent's First Name ________________________ Parent's Last Name ________________________ Address _________________________________ City ______________________ Zip____________ Email____________________________________ 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 651-621-7422 or sharon.savard@moundsviewschools.org

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.

Parent Involvement The most important factor in predicting a child’s success in school is parent involvement. Parents are an impor-tant 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 appoint-ment 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.

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

“I learned practical parenting tips at a Family Night that really work with my child.”

Preschool Parent

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 651-621-7420

Parent Education“At our family event, I was amazed at how all of the kids had learned to pass snack, pour their water, and inter-act with the other kids at the table.”

Preschool Parent

2017 – 2018 Play and Learn Preschool Tuition Assistance Form

● Yearly tuition is divided into nine (9) equal payments. ● Tuition is due by the 10th 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 (651-621-7422) 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________

Tuition Scale for Two (2) Day Per Week Class Household size

Gross Annual Income 2 3 4 5 6 7 8

0 - $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

Tuition Scale for Three (3) Day Per Week Class

Household size Gross Annual

Income 2 3 4 5 6 7 8

0 - $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

Tuition Scale for Five (5) Day Per Week Class

Household size Gross Annual

Income 2 3 4 5 6 7 8

0 - $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

Play and Learn Preschool Eligibility Form

2017-2018

Child’s Name __________________________ Date of Birth: _______________

Form Completed By: ___________________ Relationship to Child: _____________

E-mail: ___________________________________ 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 →

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

Health & Emergency Record 2017-2018651-621-7420

Complete this form and turn in with Play and LearnPreschool applicaton forms. Attach the child’s Immunization Record or your clinic can fax the record to us at 651-621-7423. 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 ________________________ Email ____________________________________________________________________________________

Parent First & Last Name________________________________ Phone _____________________________

Email ____________________________________________________________________________________

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 _____________________________

NOTE: In the event of life-threatening illness or injury and when a parent or emergency contact cannot be reached --- 911 will be called to respond and make recommendations for the child’s care.

PHOTO PUBLICATION PERMISSIONI 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 ___________

Describe any current or continuing health condi-tions. List any medications the child takes regularly.____________________________________________________________________________________

List allergies: ______________________________

List food restrictions: __________________________________________________________________

Child’s Physician/Clinic ______________________

Phone _____________________________________

Child’s Dentist ______________________________

Phone _____________________________________

Developed by the Minnesota Department of Health - Immunization Program www.health.state.mn.us/immunize (12/13)

Name ____________________________________________

Birthdate __________________________________________

Date of Enrollment __________________________________

Early Childhood Immunization Form Must be on file before a child attends any early childhood programs*

*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.

Type of Vaccine DO NOT USE () or () 1st DoseMo/Day/Yr

2nd DoseMo/Day/Yr

3rd DoseMo/Day/Yr

4th DoseMo/Day/Yr

5th DoseMo/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)• 4th dose at 12-18 months• 5th dose at 4-6 years

Indicate vaccine type: DTaP or DTPPolio (IPV, OPV)

• 2 doses in the first year• 3rd dose by 18 months• 4th dose at 4-6 years

Measles, Mumps, and Rubella (MMR)• Required for children 15 months and older• 1st dose on or after 1st birthday• 2nd 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 15-59 months, 1 dose is required• Not required for children 5 years or older

Varicella (chickenpox)• Required for children 15 months and older• 1st dose on or after 1st birthday• 2nd dose at 4-6 years

Pneumococcal Conjugate Vaccine (PCV)• Required for children age 2 - 24 months• 3 doses in the first year• 4th dose after 12 months• At least 1 dose is recommended for children age 24-59 months

in child careHepatitis 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

RecommendedRotavirus (2-3 doses between 2 and 6 months)

Influenza (annually for children 6 months or older)

5th dose not required if 4th dose was given on or after the 4th birthday

4th dose not required if 3rd dose was given on or after the 4th birthday

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 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 651-201-5503 or 800-657-3970.

Developed by the Minnesota Department of Health - Immunization Program www.health.state.mn.us/immunize (12/13)

Name _______________________________________________________

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):

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 physician/nurse practitioner/physician assistant (If disease occured before September 2010, a parent can sign.)

B. Conscientious exemption: No child is required to have an immunization that is con-trary to the conscientiously held beliefs of his/her parent or guardian. However, not following vaccine recommen-dations 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 or-der 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 conscien-tiously held beliefs for my child to receive the following vaccine(s):

Signature of parent or legal guardian _______________ Date

Subscribed and sworn to before me this: _______ day of ______________________ 20______

Signature of notary (A copy of the notarized statement will be forwarded to the commissioner of health.)

2. Exemptions to Immunization Law. Complete A and/or B to indicate type of exemption.

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

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)

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.

Signature of Parent / Guardian OR Physician / Nurse Practitioner / Physician Assistant / Public Clinic _______________ Date

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 Physician / Nurse Practitioner / Physician Assistant / Public Clinic _______________ Date

1. Certify Immunization Status. Complete A or B to indicate child’s immunization status.