CHILDREN FOR CHRIST ACADEMY



CHILDREN FOR CHRIST ACADEMY

2647 Panola Road

Lithonia, Ga. 30058

(770) 981-0039

PRESCHOOL AGREEMENT (page 1 of 4) DATE ______/____/______

1. CHILDREN FOR CHRIST ACADEMY AGREES TO PROVIDE DAY CARE FOR:

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NAME BIRTHDATE SEX GRADE ENROLLEMENT DATE

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NAME CHILD IS CALLED ADDRESS CITY/ZIP

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BIRTH PLACE HOME PHONE RELIGION

DOES CHILD LIVE WITH BOTH PARENTS? ______YES_____NO

LAST SCHOOL ATTENDED ___________________________________________________/___/____

NAME CITY/STATE DATE

FATHER OR GUARDIAN ______________________________________________________________

NAME SS# CELL/PAGER

______________________________________________________________

ADDRESS CITY/STATE ZIP CODE

MOTHER OR GUARDIAN _____________________________________________________________

NAME SS# CELL/PAGER

_____________________________________________________________

ADDRESS CITY/STATE ZIP CODE

MARITAL STATUS____SINGLE_____MARRIED____DIVORCED____ WIDOW(ER)

FATHER EMPLOYED BY: _____________________________________________________________

NAME OF COMPANY POSITION PHONE NUMBER

_____________________________________________________________

ADDRESS CITY/STATE ZIP CODE

MOTHER EMPLOYED BY: _____________________________________________________________

NAME OF COMPANY POSITION PHONE NUMBER

_____________________________________________________________

ADDRESS CITY/STATE ZIP CODE

In case of accident, if family is not available, please notify:

RELATIVE ______________________PHONE___________ ADDRESS ________________________

OTHER ______________________PHONE___________ ADDRESS ________________________

FAMILY DOCTOR _______________ PHONE____________ADDRESS ________________________

2. RELEASE STATEMENT:

At the end of the day, the child stated in this agreement, may be released to the following persons:

NAME ADDRESS PHONE RELATIONSHIP

Note: In divorce cases where one parent is not supposed to pick up the child, the school cannot refuse to release the child. At best, the child will be released and the other party notified. The only exception is to provide the school a copy of a court order.

3) FEES – Registration fees are non-refundable. All weekly tuition is due in advance on the Wednesday before the upcoming week by 6:30 p.m. Payments received on Thursday or Friday are considered late and must include a $15.00 late payment fee. If payment is not received by 6:30 p.m. Friday, your child will not be allowed to attend school on Monday.

There will be no waiver or reduction of weekly tuition fees for partial attendance, holidays, sickness, vacation etc. This is to maintain continuity in the level of service provide as well as reserve your child’s space in his or her absence. However, after 6 months of consecutive enrollment, year round students will be eligible for a one week vacation where tuition is waived during the summer months only (June, July, and August).

4) WAIVER OF LIABILITY

In the case of accident or illness: Should my child become ill during the time that he/she is in the care of Children for Christ Academy, or should suffer an accident of any character, the school is to contact me immediately. In the event that the school is unable to reach me immediately, the school shall be authorized to secure medical attention and care for the child as deemed necessary. If such an event shall occur Children for Christ Academy, Inc. or any of its employees shall be held blameless.

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SIGNATURE OF PARENT/GUARDIAN DATE

LISTED BELOW ARE KNOWN ALLERGIES: TREATMENT:

Bee Stings / Insect Bites _________ ______________

Plants ________________________ ______________

Drugs ________________________ ______________

Foods ________________________ ______________

List here any physical defects such as; physical problems, mental health disorders, mental retardation or developmental disabilities which would limit the child's participation in the Academy's program and activities. ___________________________

FOR HEALTH & SAFETY REASONS, PLEASE DO NOT BRING TOYS, FOOD OR JEWELRY.

Any child that has been sick with a communicable disease will not be allowed to attend school without written release from a doctor (strep throat, flu, ringworm etc.) Any parent leaving a child in such instances will be subject to returning to school and picking up their child. Children for Christ Academy will not allow other children to be exposed to ill children.

SIGNATURE OF PARENT OR GUARDIAN DATE (Sheet 2of 4)

CHILDREN FOR CHRIST ACADEMY

PRE-SCHOOL AGREEMENT - Policies and Procedures (sheet 3 of 4)

Parent(s) please note:

1. The school will be open Monday through Friday 6:30 am until 6:30 pm except on the following Holidays:

New Year’s Eve

New Year’s Day

Dr. M. L. King Day

Presidents’ Day

Good Friday

Spring Break (2 days)

Teacher’s Workday

Independence Day (July 4th)

Labor Day

Staff Development Day

Thanksgiving Holidays

Christmas Holidays (Please see pre-school calendar for actual closing dates.)

2. Children for Christ Academy will provide two (2) meals, breakfast and lunch. An afternoon snack will also be provided. Breakfast is served from 7:00 am until 8:15 am. After 8:15 am breakfast will not be served.

3. In the event of life threatening injury or illness, the Academy will call 911 Paramedics and parent(s) immediately and the child will be taken to Dekalb Medical Center or the best facility determined by the Paramedics. For non-emergency events, when professional medical attention is required, the parent(s) will be notified and the parent’s instructions will be followed until the child can be picked up or returned to class.

4. If your child does not adjust to our program, you will be asked to withdraw your child / children. The Academy will give you a two weeks notice.

5. A written two weeks notice must be given to the Academy before removing your child(ren) from our program. We also ask that an Intent Form be completed at that time. In the event the parent(s) do not give two weeks notice, they will be responsible for the tuition for those two weeks.

6. If your child is on a special diet, or cannot eat certain foods, this information must be given to the Academy in writing, with your signature along with a written statement from a medical source. This information will become part of your child's Academy file.

7. Children are accepted at the age of six (6) weeks. Please leave the appropriate amount of disposable or cloth diapers for your baby's daily changing. If you have a toddler we ask that you leave one (1) dozen diapers at the Academy in case your child has an accident.

8. The Director must be notified if anyone other than an individual authorized on the application form is to pick your child up.

9. Please notify the Academy of any change in your personal or business address or telephone number in order that we may be able to reach you should it become necessary.

10. We welcome and encourage conferences between parent, director and teacher concerning your child's progress.

11. Children who turn three (3) years of age during our regular school year, will remain grouped with other two (2) year olds for the remainder of the school year.

12. For your child's safety, and in accordance with state law, an immunization record from the child's doctor is required. This record is to be updated annually, or whenever it becomes necessary during the year. No child(ren) shall continue enrollment in the Academy for more than thirty (30) days without this information being current.

13. In the interest of health and safety of all children, any child showing signs of illness will be isolated immediately and the parent called to pick up the child. Children with diarrhea or a fever will not be allowed to remain at the Academy under any circumstances.

14. If your child is to be given prescribed medicines, the container must be labeled with the child's name and hours to be given. Additionally, the parent must complete and sign the medicine sheet. We cannot administer any medications without written instructions from the parent.

15. All belongings and clothing must be marked with the child's name in indelible ink or with a name tag. We prefer a change of clothing to be left at the school.

16. Please contact the Director if you have a special request, such as a birthday party for your child, etc.

17. "Special Notices" to the Parents will be posted in the lobby periodically.

18. We ask that you drive slowly and cautiously while in our parking lot, as little ones are being picked up and delivered during all periods of the day.

19. Entrance and Exit signs are to be followed, in order that the flow of traffic will move smoothly and mishaps may be avoided.

20. Parents, or persons authorized by the parent(s) to pick up or drop off a child at the Academy, must escort the child in or out of the building when entering or exiting the Academy.

21.Children For Christ Academy will not be responsible for minor children left unattended in vehicles, or for items stolen as a result of vehicles left running, unlocked and unattended in the parking lot.

I (we) hereby agree to comply with the rules and regulations of Children for Christ Academy regarding fees, attendance, health, parking, holidays, clothing and all other items specified in the Policies Form issued by the Academy.

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Parent /Guardian Signature Date (sheet 4 of 4)

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