Child Enrollment Application Parent / Guardian 1 Emergency contact and authorized to pick up child
Parent / Guardian 2 Emergency contact and authorized to pick up child (if applicable)
Additional Emergency Contacts People authorized to pick up your child
Special Medical Information, Medications, Allergies, Diet
Does your child often get a diaper rash?
Is your child toilet trained?
How do you discipline your child?
What is your child's current sleeping schedule?
Has your child been taking an afternoon nap?
Special family situation? (custody specifications, problems arising from situations, etc.)
Previous child care attended? (Problems?)
Any disorders/developmental (slow/advanced) diagnosed or suspected?
Expectations of Learning All Hours, LLC?
Has the child ever been hospitalized?
How does your child typically react to new people or unfamiliar situations?
What kind of things can your child do by him/herself? (eating, dressing, washing hands, toileting, tying shoes, etc.)
Does your child have any behavior issues you are concerned about? If yes, please describe and explain how you deal with them at home
Please list names and ages of your child's siblings or other children living in the household
Is your child interested in books?
Do you have any pets in your home?
Please list your child's special interests and abilities
Are there any additional things you'd like to share about your child?
Parent Contract Agreement
I/We, the parent(s) and/or legal guardian(s), do hereby agree to the following:
I/We agree to pay on the first day of the week of care (Monday), unless a holiday falls on the week of care. If I am unable to pay on the first day of the week, I will sign a payment agreement that must be paid no later than Wednesday morning of the same week in the AM BEFORE my child(ren) are dropped off for care.
I/We understand that a return check will be charged a fee of $35.00 for the 1st 30 minutes late and an additional one dollar for each additional minute thereafter; a late pick-up fee is charged after 10 hours of care, or when child is left after childcare closing hours. For POC, this will be in conjunction with an hourly fee of more than 10 hours of care, if applicable.
Learning All Hours is a Purchase of Care Plus program. I/We agree to pay the full difference of care that Purchase of Care will not cover and any and all assigned copay assigned by the Division of Social Services, Purchase of Care Contract.
I/We understand that once enrolled, our child will have 2 weeks of unpaid childcare in a year. I/We understand that a written notice prior to the weeks taken is to be written and given to Learning All Hours staff. Absences due to sickness, parental custody agreement weekly visits that cause child to be out of care, are not exceptions to this payment agreement.
I/We will inform Learning All Hours in writing 5 days in advance before withdrawing child from care. I/We understand that if the withdraw notice is not written, that you are responsible for care until written notice is received.
In the event of a physical accident or emergency illness, Learning All Hours has permission to administer care as trained in CPR/First Aid as it sees fit for the child's best outcome. I/We understand that Learning All Hours requires current and updated medical insurance policy information regarding the enrolled child(ren).
I/We do hereby consent to allow Learning All Hours officials and Teachers and staff care for our minor child(ren). I/We hereby release and hold harmless Learning All Hours and/or employees of Learning All Hours from liability for any harm, injury or damage which my child(ren) may suffer and/or sustain while in care during routine care, supervision, activities, and instructions, etc.
Parent and/or guardian acknowledge by signing this agreement that they have reviewed parent contract, parent handbook, and agree to the terms as it relates to the Learning All Hours program.
I/We understand and agree that should the administrator of Learning All Hours program feel that my/our child(ren) cannot adjust to the program, that the child will be disenrolled in 5 days.
I/We understand that our child(ren) will not be released to any others that have not been listed as an authorized person to pick up your child. I/We further understand that a physical, current identification from the person authorized, and parent must be shown at pick-up. Children will never be released if the administration should feel that the adult picking up is under the influence of drugs and/or alcohol.
Parent and/or guardian will be given written notice in advance of any childcare fee increases. Learning All Hours reserves the right to change the terms of this agreement and/or provide additional rules of regulations and/or policy and will provide notice in writing of the changes immediately.
Child's Contracted Schedule Drop-off and pick-up times. Care is provided within these hours only unless a new contract of care is completed.
Center Required Policies & Permissions Please review and check each item you acknowledge or authorize
Transportation: any special needs or problems requiring special attention during transportation
Photo & Video Permissions For each use, select Grant or Decline
Display in facility's personal scrapbook
Give photographs possibly containing your child to current clients
Display in facility's scrapbook or bulletin boards, shown to current and prospective clients
Display still photos on child care website (first names only)
Post photos on child care's Facebook page
Give video to current parents
YouTube promotional video
Typing your full name below constitutes your electronic signature and agreement to all sections completed above. The Child Health History & Immunization form must still be completed by your child's physician and returned to the center.
Submit Enrollment Application