ENROLLMENT INFORMATION



ENROLLMENT INFORMATION

Facility Name First Step School Owner/Director Tina Owens

Child’s Name _________________________________________ Date of Birth ______________________

Child’s Address _____________________________________________ Home phone #_____________________

______ _________________________________ Cell number (m)__________________(d)______________

Date of admission _______________ Hours and Days child in care ____________________

Parent/Guardian Name____________________________________________________________

Address if different from Child’s__________________________________________________

List of numbers where parent can be reached during the day:

Dad’s Name:______________________________________ Mom’s Name:______________________________________

Dad’s: Name of Workplace___________________________ Mom’s: Name of work place___________________________

Work Address: _____________________________ Work Address:______________________________

City, State, Zip _____________________________ City, State, Zip ______________________________

Dad’s DOB: ___________________ Work #__________________ Mom’s DOB: _____________ Work #___________________

Dad’s email_______________________________________ Mom’s Email:______________________________________

Emergency Contact: Name__________________________________ Phone #_____________________

Address:______________________________________________________________________________________________

Specials Needs/Allergies_________________________________________________________________________________________

Authorization for Emergency Medical Care

In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize the facility director or person in charge to take my child to: Name of Licensed physician ________________________________________________

Address of physician__________________________________________ Phone #_________________

______________________________________

OR TO THE HOSIPITAL: Name______________________________________ Address__________________________________

I give consent for necessary emergency treatment when my child is in the care of this physician and/or hospital.

Signature of Legal Guardian_______________________________ Date_________________

My child attends: Name of Public School___________________________ Tel #__________________________

School Address_______________________________ __________________________________

My child’s immunization record is on file at the school and all immunizations and tuberculosis test results are current.

Parent Signature/Guardian_________________________________ Date_________________

The following people may pick my child up from school: (List mom/dad too) (relationship)

Name___________________________________ phone #_____________________ ____________

Name___________________________________ phone #____________________ ____________ They will have to present

Name___________________________________ phone #_____________________ _____________ the school with a driver’s

Name___________________________________ phone #_____________________ ____________ license! Safety of the child!

Name___________________________________ phone #_____________________ _____________

Name___________________________________ phone #_____________________ ______________

Name___________________________________ phone #_____________________ _____________

Parent statement: My child has been examined within the past year by a licensed physician and is able to participate in the day care program:

Name and Address of physician or EPSDT site____________________________________________________________________________

__________________________________________________________________________________________________________________

Signature of Parent/Guardian__________________________________Date___________________

Note: If medical diagnosis and treatment and/or immunization conflict with your religious beliefs, you must sign an affidavit to that effect and attach to this form. (Continued on back)

If immunization would be injurious to your child or family, you must obtain a certificate (signed by a physician) to that effect and attach to this form.

Signature of Parent/Guardian__________________________________Date___________________

The following signature verifies that I give permission to ride the bus to and from school or to be released to be released to the care of a sibling under 18 years of age, if applicable.

Signature of Parent/Guardian__________________________________Date___________________

I hereby give my consent for First Step School to provide transportation for my child ___________________ on excursion or other planned field trips away from the facility conducted and supervised by facility staff, or in an emergency situation.

Signature of Parent/Guardian__________________________________Date___________________

I hereby give my consent for my child ________________ to participate in water activities provided and supervised by First Step School. This includes ice play, small tub play, sprinklers, etc. (NO SWIMMING POOLS)

Signature of Parent/Guardian__________________________________Date___________________

I hereby acknowledge that I expressly grant to the First Step School and to its employee, the right to take pictures of my child___________________, and use his/her picture, voice and other reproductions of physical likeness as the same may appear in any television programs, video recording, motion picture film or still photograph. (We take lots of pictures of the children to hang up in the school)

Signature of Parent/Guardian__________________________________Date___________________

I give my permission for authorized personnel to administer to my child named above the appropriate dosage of Tylenol or Motrin for fever, headaches, or minor aches and pains and Benadryl or its equivalent Jr. for allergic reactions

Signature of Parent Guardian___________________________________ Date _________________

As the parent/guardian of ________________, I give permission for the staff at First Step School to apply sunscreen to my child when he/she is going to play outside. I understand the sunscreen can be applied to my child’s face, tops of ears, nose, bare shoulders and legs. *

Signature of Parent Guardian___________________________________ Date _________________

___I ____________________ DO give First Step School Inc. Permission to publish school related photos of my child on the website. I understand I have the right to ask First Step to remove them at any time.

__I _____________ DO NOT give First Step School Inc. Permission to publish school related photos of my child on the First Step School Website.

_____________________________ _______________________

Parent/Guardian Signature Date

___I ____________________ DO give First Step School Inc. Permission to publish school related photos of my child on their Facebook account page (for advertising purposes). I understand I have the right to ask First Step to remove them at any time.

__I _____________ DO NOT give First Step School Inc. Permission to publish school related photos of my child on their First Step School Facebook page (for advertising purposes).

_____________________________ _______________________

Parent/Guardian Signature Date

Basic Rules of the Center

• If you are enrolling your child for any length of time (month or longer), you understand that a 30 day notice in writing must be given to the office if a child is withdrawn. Otherwise, I understand that one month’s tuition will be charged and due regardless of the child’s attendance. The allotted yearly vacation time is given on a yearly basis and may not be sued in the 30 day notice or last month’s tuition fee and only to full time year around students.

• All children must arrive at the center before 9 am or after 2 pm. There is no drop off during the time frame of 9am-2pm due to nap and lunch conflicts. Unless we have a Dr’s note that your child was at the Dr. and it must be arranged with the office at least 1 day in advance.

• Tuition payments are due at the beginning of the month on the first or you can choose the payment option of half due on the first and half on the fifteenth. If the first or fifteenth should happen to fall on the weekend/Holiday, then the tuition is due the last working day we are open before. If it is not paid at that time, there is a $5 a day late fee until paid. Enrollment may be terminated if tuition and upaid late fees is not paid within 5 days.

• If you are acting as a drop-in you must pay for daily drop in rate when you drop your child off in the morning. There is a payment drop box with a lock by the exit door.

• If you are purchasing hot lunches, you must pay the entire amount at the beginning of the month and the check must be separate from the tuition check.

• You may not use a vacation prorate during holiday time. It has to be 5 consecutive days when the center is open for operation.

• Your tuition will not be prorated when we are closed for any Holidays.

• The First Step School provides full time and drop in care to children I month to 12 years of age. The overall goal of the program is enhancement of the child’s emotional, social and cognitive development. Children’s learning experiences are planned to occur through play activities and planned educational activities. Children and teachers select activities for participation from a variety of available planned experiences, some of which are child initiated and some of which are teacher initiated. First Step School is based on a Cognitive Philosophy.

• The Staff possesses a high level of expertise and training. The teachers observe and plan for developmentally appropriate experiences for the child within a group setting. First Step is in compliance with Texas Department of Protective and Regulatory Services teacher to child ratios.

• Guidance and discipline are words used to describe adult attempts to influence the child’s behavior. We try to help the child develop a positive self image, control his/her own behavior, behave appropriately in a group setting and learn to express emotions appropriately. Direct guidance strategies are also used at the Center. These include reasoning with the child regarding behavior or limits, physical closeness and verbal communication such as setting limits, redirecting behavior, etc.. The harshest method of guidance used as punishment is the removal of the child from the group or a time out. The child is always with in the view of an adult. Spanking or other physical punishment is NEVER used at the school.

• Each child will need a water bottle everyday that is clearly labeled with your child’s name.

I agree to adhere to these policies and procedures as an enrolled client of First Step School.

Signature of Parent/Guardian__________________________________Date________________

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