Parkview Christian Schools



Parkview Child Development Services, LLC.North Creek Child Development Center Superior Child Development Center Growing Hearts Child Development Center Parkview Carol Yoakum CDC 2070 Fletcher Ave, Lincoln, NE 68521 4645 N. 26th Street, Lincoln, Ne 68521 4400 N. 1st Street , Lincoln, Ne 68521 4621 NW 48th Street, Lincoln, Ne 402-477-5440 402-476-8600 402-474-5820 402-325-0492 Child Enrollment Form Child(ren) Enrolled: DOB Nickname____________________________________ _______________ __________________________________________________ _______________ ___________________________________________________ ______________ ___________________________________________________ ______________ _______________Date care began:__________________ Date care ceases:____________________ Parent or Legal Guardian Information:Mother___________________________________ Father _______________________________________Address__________________________________ Address______________________________________City/Zip__________________________________ City/Zip______________________________________DOB____________________________________ DOB________________________________________Social Security____________________________ Social Security________________________________Cell Phone________________________________ Cell Phone___________________________________Alternative Phone__________________________ Alternative Phone_____________________________Email____________________________________ Email_______________________________________Employer_________________________________ Employer____________________________________Work Address_____________________________ Work Address_______________________________Work Number_____________________________ Work Number_______________________________Marital Status Married Separated Divorced Single Custodial Parent____________________________________________________________________Person(s) to whom to whom my child(ren) may be released to. Please make individuals aware that the staff of Parkview Child Development Services LLC. are required to ask for picture identification of anyone who desires to pick up a child from the center. It is important to keep these names updated as children are not allowed to leave with anyone that is not on this list.Name ___________________________________ Name _______________________________________Relationship to family______________________ Relationship to family __________________________Phone Number ___________________________ Phone Number _______________________________Name __________________________________ Name _______________________________________Relationship to family _____________________ Relationship to family __________________________Phone Number ___________________________ Phone Number ________________________________Emergency ContactsIn the event of an illness or an emergency when the parent(s) cannot be reached, the following person(s) will be contacted and are authorized to pick up, supervise and/or consent to medical treatment for the child(ren)1.Name________________________________________Address____________________________________Phone (cell)___________________________________(work)_______________________________________Relationship to child________________________________________________________________________2. Name________________________________________Address___________________________________Phone (cell)___________________________________(work)______________________________________Relationship to child_______________________________________________________________________3. Name________________________________________Address___________________________________Phone (cell)____________________________________(work)_____________________________________Relationship to child_______________________________________________________________________Allergies/Medical Conditions/Special Needs ____________________________________________________________________________________________________________________________________________________________________________________Physician: ____________________________________________ Phone: ______________________________Clinic: ____________________________________________________________________________________Hospital: __________________________________________________________________________________Dentist: ___________________________________________Phone: _________________________________Insurance Carrier/ ID Number_________________________________________________________________In the event of an emergency, I ___________________________________ give permission for the staff of Parkview Child Development Services to seek any medical treatment necessary for my child(ren): ______________________________________________________________________________________ ______________________________________________________________________________________Parent Signature_________________________________________ Date _________________________Health HistoryPlease list any special needs, health issues (including allergies), disorders/diseases (ie: asthma, eczema, etc)Any medical issues or medication that we should be aware of:Child’s Name: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Child’s Name: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Child’s Name: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Child’s Name: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Medication Competency Statement:I, __________________________ have determined Parkview Child Development Services, Director and/or staff competent to give or apply medication to my child(ren).Signature of parent: ______________________________________________ Date: _____________________A copy of your child(ren)’s immunization record must be submitted with this enrollment packet. Immunizations must be up-to-date and parents are responsible to provide Parkview Child Development Services with updates of immunizations each year.Schedule: Please fill in the times that each child will be present at the centerChild’s Name: __________________________________Monday __________ Tuesday_________ Wednesday __________ Thursday ________ Friday __________Child’s Name: __________________________________Monday __________ Tuesday _________ Wednesday __________ Thursday _________ Friday ___________Child’s Name: __________________________________Monday __________ Tuesday _________ Wednesday __________ Thursday _________ Friday ___________Child’s Name: __________________________________Monday __________ Tuesday _________ Wednesday _________ Thursday _________ Friday ____________ Parkview Child Development Services, LLC Growing Hearts CDC North Creek CDC Parkview Carol Yoakum CDC Superior CDC Payment Agreement_______________________Parent /Guardian Name_____________________________________________________________________________________Address___________________________________________________________________________ Zip Code _______________Cell Phone ________________________________ Work Phone _________________________________________Date this agreement/change is to take effect ___________________________________________________Child’s NameDate of BirthAge GroupCenterTuition Rate for ChildPlease initial each line below_____Tuition is based on enrollment, not attendance. Fees are not reduced for absences, change in hours or holidays. Tuition amounts are based on the age of your child(ren) and is assessed on a monthly rate. _____Payment is due in advance of care provided_____Late pick up fees are due to the center’s office within 24 hours of the late pick up. _____All families receiving Title XX subsidy will be charged their family fee (co-payment) if it applies. _____All families receiving Title XX subsidy are responsible for obtaining service authorizations and any care provided outside of the authorized dates or times will be the family’s financial responsibility_____Families will be assessed a $5 per day charge if they neglect to sign their child(ren) in/out each day_____Payment agreement must be signed, and method of payment agreed to, prior to services being provided. A two week notice needs to be given for any change in tuition that will warrant a new payment agreement. Failure to return a completed agreement will result in denial of care_____You will receive a tuition statement reflecting all billing for the prior month. Please note that if an election is made to make payments on a weekly schedule, there will be months where your statement balance will show a prepaid amount. This will occur when the last day of the month is not a Friday. In addition every January you will receive a tax statement reflecting all tuition paid to Parkview Child Development Services for the previous calendar year. _____A two-week notice is required before withdrawing a child from the center. Failure to give a two-week notice will result in two-weeks of tuition charges being added to your account_____Your child’s place will be filled after five consecutive days of no contact_____Failure to follow your payment agreement will result in termination of services_____Other fees, such as field trip and activity fees must be paid separate of auto withdrawal or credit card payment_____Each family is allowed one week of free child care per enrollment year upon their anniversary date. If your child attends 5 days a week, they will receive 5 days of vacation. These days must be consecutive. The child may not be in attendance when their vacation days are used. The vacation request form must be turned into the center director in advance of days to be taken._____In the event of extended absence of care, in order to hold your child’s spot the following must be meant *One month without pay( During this month your child can not be in attendance at the center) *You will be required to pay the other months of absence. If care is needed during this period of time arrangements must be made in advance with the center director *Failure to meet these requirements may result in the loss of your child’s spot at the center_____$15 late tuition fee will be assessed at any time during the month that tuition payments fall behind_____Accounts will be turned over to Professional Choice Recovery if payment arrangements are not consistentPlease indicate your preferred method of payment by marking and filling out section A, B or CA: Automatic withdrawal (Information must be uploaded on Smartcare)__ Twice per month (1st and 16th day each month) Amount$_____________ __Monthly (1st or first business day of each month) Amount $____________B: Credit Card Option _____ Master Card _____ Visa _____DiscoverPlease upload information on Smartcare____ Weekly: day to be withdrawn each week _____________ Amount $_____________________________ ____ Twice per month: date to be withdrawn______________ Amount $________________________________ Monthly: date to be withdrawn_____________________ Amount $____________________________C: Check, Cash, Money Order _______ Weekly Amount $________________________ I agree to pay on Monday or the first business day of each week_______Twice per month Amount $___________________ I agree to pay on the 1st and 16th day of each month_______Monthly Amount $_______________________ I agree to pay on the first business day of each monthA fee of $35 will be assessed to any Non-sufficient funds check.D: State Subsidized Childcare (Title XX) Is your child a state ward? _____ Yes _____NoFamily Fee Amount $_________________________ If you have a copay, you must also complete section A, B or C____________________________________________________________________________________________________________Parent/Guardian Signature Parent/Guardian Social Security Number Date____________________________________________________________________________________________________________Approved by Center Director Signature Date Illness PolicyChild(ren)’s Name _____________________________________________________ Date _______________Children must be in good health to attend Parkview Child Development Services. Please do NOT bring your child to school if they are ill or cannot fully participate in the daily indoor and outdoor program. In order to prevent the spread of illnesses, please keep your child at home if they display any of the following symptoms. If your child becomes ill with any of the following symptoms while in care, you will be notified immediately. If you cannot be reached, the center director will call one of the emergency contacts listed in your enrollment packet.For the health and safety of your child(ren) and others at the center your child will be sent home for the following reasons:Vomiting more than 2 times in a 24 hour period. Children may return to the center 24 hours after the symptoms have subsided.Diarrhea 2 watery stools in 24 hours or 1 diarrhea blowout. Children may return to the center 24 hours after the last symptom has subsided.Conjunctivitis/Pink Eye, children with red, itchy, draining or crusty eyes may have an infection. Children may return to the center after 24 hours of successful antibiotic treatment.Fever of 100.5 or higher, children may return to the center 24 hours after being fever free without Tylenol or similar products.Rashes/Skin conditions such as impetigo or contagious cold sores. A doctor should examine any unusual rashes. Children may return to the center after all symptoms are gone or the child’s doctor has provided written clearance to return.Chicken Pox, children with chicken pox may exhibit a low grade fever, rash, blisters, scabs, or malaise. Children may return to the center after sores are scabbed over and dried. (usually 7-10 days)Lice/Hair Infection, children may return to the center 24 hours after shampoo treatment and all nits/eggs are gone.Other symptoms, children will be excluded from care if the center director determines it is inappropriate for the child to be at school. All exclusions due to illness are under the final decision of the center director.Parent Signature______________________________________________________ Date _________________ Family Enrollment Check ListChild’s Name _______________________________________________________DOB ___________________________________Child’s Name _______________________________________________________DOB ____________________________________Child’s Name _______________________________________________________DOB_____________________________________Date Enrolled ______________________________________________Date Care Ceases ___________________________________________Referred by _________________________________________________________ Enrollment Packet_________ Enrollment Fee Amount Paid $_____________________ Birth Certificate_________ Shot Record_________ Parent Information Brochure for Child Care Signed and Dated_________ CACFP Food Program Form, Signed & Dated Kept in IEF Folder_________ Emergency Contacts_________ List of whom child can be released to_________ Acknowledgement of Parent Handbook_________ Parent Permission Form_________ Transportation Permission Form_________ Illness Policy_________Contract for Services_________ Feeding Chat for Infants- Make copy and put in Infant room_________ All about my baby- Make copy and put in Infant room_________ Behavior Guidance Policy Behavior Guidance PolicyParkview Child Development Services, LLC, uses discipline measures designed and carried out in such a way to help individual children develop self-control and to assume responsibility for their own actions.Methods of Behavior GuidanceDistraction: Changing of a child’s focus from an activity that is unacceptable to one that is acceptable without confronting inappropriate behaviorsRedirection: Involves anticipating problems and intervening, before they occur, with a solution Ignoring: When the behavior is neither harmful nor dangerous to the wellbeing of the child or any other child in careTime-Away: Time away interrupts the inappropriate or harmful behavior by removing the child from the situation. Short periods of time are used ranging from 10 seconds to a few minutesPersistent Inappropriate Behavior ProceduresWe will observe and record the child’s inappropriate behaviorWe will document what we have done to try to change the behaviorIf the inappropriate behavior continues (up to 3 incident reports) the teacher will make contact with the parent to discuss the plans to change the behavior. If the behavior continues after the parent has been contacted the fourth incident will result in suspension for the day. At this time a meeting will be set up by the center director with the parent and teacher to discuss further plans to change the negative behavior. If the child has been sent home 3 times for “day suspension” it will result in immediate termination. Guidelines for Paret Contact, Suspension and DisenrollmentAny child whose behavior creates a significant risk or harm to the safety of the other children and staffSubstantial damage to the center or personal propertyAny attempt to physically assault a child or staff member, which would result in serious bodily injuryAny inappropriate language, written or verbalAcknowledgement of Behavior Guidance PolicyParent/Guardian Signature ________________________________________ Date ________________Suspension 1: Parent Signature _____________________________________ Date ________________Suspension 2: Parent Signature _____________________________________ Date ________________Suspension 3: Parent Signature _____________________________________ Date ________________Parent Permission FormPermission to TransportI give Parkview Child Development Services LLC, permission to transport my child(ren) to the following school (circle the one that applies) Campbell Elementary School Kooser Elementary School Arnold Elementary SchoolMy child _______________________ is in ______ grade and is in __________________ class.My child _______________________ is in ______ grade and is in __________________ class.I understand that once my child(ren) is dropped off on school premises Parkview Child Development Centers is not responsible for supervision of my child(ren).I give Parkview Child Development Services LLC permission to transport my child(ren) to approved field trips after an advance notice has been received.Parent Signature ___________________________________________________ Date _______________________Permission to PhotographI give Parkview Child Development Services LLC, permission to photograph and post my child(ren)’s images within the center or on the center’s Facebook page. I understand that my child(ren)’s photographs may be used in informational and promotional articles including newsletters, newspaper articles and brochures.Parent Signature _____________________________________________________ Date _______________________Permission to apply Bug Spray and Sun BlockI give permission to Parkview Child Development Services LLC, permission to apply bug spray and/or Sunblock to my child(ren) when needed.Parent Signature ______________________________________________________ Date _______________________Parkview Carol Yoakum CDC Family ONLYPlease complete the following questions. These are kept confidential and will not be shared with any individual at any time. These are needed for census and for numbers only. Names will not be divulged at any time. My family is currently a Lincoln Housing Authority tenant_____ Yes _____ NoMy family is currently on the Lincoln Housing Authority wait list_____ Yes _____ No (Infant ONLY Form) ALL ABOUT BABYMy full name is _____________________________________________________My nickname is _____________________________________________________My birthday is ______________________________________________________My mom’s name is __________________________________________________My dad’s name is ____________________________________________________Infant Feeding Schedule I drink ________________ ounces, every __________________ hoursI have started eatingInfant Cereal: Yes No Baby food: Yes No Table food: Yes NoPlease circle any baby foods that your child has been introduced toRice Cereal Peaches Pears Applesauce Bananas Green BeansPeas Carrots Squash Sweet Potatoes Meat Oatmeal Cereal *Please keep staff up to date when you introduce new foods to your babyStaff will not feed your child food that has not already been introduced at home by parents.Allergies ____________________________________________________________________Other Health Concerns ________________________________________________________Things I like/dislike ___________________________________________________________Parent Signature _____________________________________ Date ___________________If your child is sleeping do you want us to wake them to be changed or fed?If your child becomes ill while in our care, who should we contact first?_____________________________________________________________________________When your child is upset, how do you soothe him/her?_____________________________________________________________________________In the event of an emergency (fire/tornado) and no access to your child’s formula or breast milk do we have permission to use the center formula?____________________________________________________________________________ Other information you would like us to know about your child_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________Parent Signature ___________________________________________ Date _______________(INFANT ONLY FORM) About My BabyChild’s Name _______________________________ Date of Birth ________________Nickname __________________________________Parents Names ____________________________________________________________________________Sibling’s names and ages How does your child sleep best?How long do they usually sleep at one time?How often do they usually nap?What does your child eat?How much and how often does your child eat?_____________________________________________________________________________Are there any foods that your child should avoid? ................
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