Precious Hearts Learning Center, Inc

Precious Hearts Learning Center, Inc.

POLICY ACKNOWLEDGEMENT

I have reviewed the Emergency Action Plan (EAP). I agree to adhere to this policy.

______Signature of Staff Member Date

______Signature of Parent Date

______Signature of Director of Precious Hearts Learning Center, Inc. Date Admissions Contract

CHILD’S NAME: ______

ADMISSION DATE: ______

DAYS ENROLLED: ______

HOURS PER DAY: ______

RATE OF PAY: ______

PAYMENT DATE: ______

I/we, the parent(s) or legal guardian(s), of the above mentioned child, agree to sign and abide by the rules of the parent handbook for Precious Hearts Learning Center, Inc. It is also understood that if for any reason I/we need to remove my/our child from the Center, I/we will provide a two weeks written notification or the equivalent of two weeks payment. In the event that collection procedures are necessary, I/we agree to pay collection costs and attorneys fees.

PARENT’S SIGNATURE: ______Social Security#______Date: ______

PARENT’S SIGNATURE: ______Social Security# ______Date: ______

MOM’S E-MAIL INFO: ______

DAD’S E-MAIL INFO: ______

PRECIOUS HEARTS LEARNING CENTER, INC.

ASST./DIRECTOR’S SIGNATURE: ______

OWNER/PRESIDENT SIGNATURE: ______

DATE: ______HEALTH PERMISSION

THIS DOCUMENT IS MY CONSENT AS PARENT OR GUARDIAN OF

______FOR ANY TREATMENT OR PROCEDURE DEEMED

NECESSARY BY THE PROFESSIONAL STAFF OF ______HOSPITAL.

PARENT SIGNATURE: ______DATE: ______

WITNESS SIGNATURE: ______DATE: ______

INSURANCE POLICY NUMBER: ______

INSURANCE COMPANY: ______

NOTARY PUBLIC SIGNATURE: ______DATE: ______

NOTARY PUBLIC SEAL Precious Hearts Learning Center, Inc.

CHILDCARE AGREEMENT

I (We) the parent(s) or legal guardian(s) of ______Agree to abide by these tuition policies and furthermore agree:

1. To read and familiarize myself (ourselves) with the policies and procedures in the Center’s Parent Policy, before my (our) child’s first day.

2. To abide by illness policies as outlined in the Parent Policy, i.e.

a. To pick up my child promptly if notified of illness b. To keep my child out of school when fever, vomiting, or diarrhea are evident, and for 24 hours after symptoms stop c. To keep my child out of school for 24 hours after starting on antibiotics

3. To notify the Center immediately if my child contracts a contagious illness. It is the responsibility of every parent to help safeguard the health of all children in attendance

4. To contact my child’s coordinator or the director whenever I have unresolved concerns about my child’s participation in the program.

5. To contact my child’s coordinator if there are any changes at home which may have either a positive or negative effect on my child’s well being or attitudes. Any information will be regarded as confidential, shared only with staff directly involved with my child.

6. To sign my child in and out on the attendance roster daily.

Parent or Guardian Signature/Date:______

Director’s Signature/Date:______Precious Hearts Learning Center Phone Directory and Child Picture Release Form

Precious Hearts Learning Center would like to request your permission to give your phone number to other parents at PHLC if they request it. We would also appreciate your permission in allowing your child(ren) to be photographed &/or video-taped through PHLC, for the purpose of news coverage, child development training videos, etc… Please let us know if you would like you and your child to be included.

Check Two:

I authorize release of the following information for Precious Hearts Parents only. Please sign below.

I give my permission for my child(ren) to be video-taped &/or photographed.

I do not wish to have my phone number released.

I do not wish my child(ren) to participate in being video-taped &/or photographed.

Please fill out as much of the following information that we may release.

Child’s Name

Child’s Home Phone #

Child’s Home Address (optional)

Mother’s Name Father’s Name

Authorized Signature:

Thank You for your participation. Rating/Home Movie Titles Recording Educational Check Please make a check in the row if your child may watch the film. Leave it blank if not allowed to view.

8 Seconds PG-13 For Love of the Game PG-13 Ghostbusters PG Ghostbusters II PG-13 Grease PG Harry Potter PG Shrek PG, DVD & VHS Dinosuars Not Rated

An American Tail G An American Tale: Fievel Goes West G Children's Classical Cartoons: Jack Frost Not Rated Rainbow Brite Not Rated Scamper the Penguin Not Rated The Brave Little Toaster Not Rated The Land Before Time G The Little Fox Not Rated Wallace & Gromit Not Rated We're Back G A Bug's Life G Antz PG Balto G Duck Tails: Treasure of the Lost Lamp G Pocahontas G Rock a Doodle G The Aristocrats G The Fox and the Hound G, DVD The Lion King G The Secret of Nimh G Thumbelina G 101 Dalmatians G

Parent Initials: Rating/Home Movie Titles Recording Educational Check Please make a check in the row if your child may watch the film. Leave it blank if not allowed to view.

Adventures in Dinosuar City PG Alice in Wonderland Hallmark Amazing Panda Adventure PG Andre PG Angels in the Outfield PG Babe G Black Beauty G Born to be Wild PG Casper PG Cool Runnings PG D2: The Mighty Ducks PG D3: The Mighty Ducks PG Ed PG Far from Home: Adventures of Yellow Dog PG Flash G Flipper PG Fluke PG Gordy G Homeward Bound G Homeward Bound II G Iron Will PG Little Big League PG Little Giants PG Little Rascals PG Mighty Joe Young PG Mouse Hunt PG MVP 2 Most Vertical Primate G My Favorite Martian PG Peter Pan Not Rated Richie Rich PG Spy Kids PG Stuart Little PG That Darn Cat PG The Indian in the Cupboard PG The Little Vampire PG The Princess Diaries G The Sandlot PG

The Second Jungle Book: Mowgli & Baloo PG Thomas & the Magic Railroad G Tom and Huck PG Toy Story G Willy Wonka and the Chocolate Factory PG, DVD Zeus and Roxanne PG

A Trip to the San Diego Zoo Not Rated Edu Film Amazing Animals: Monkeys & Apes Edu Film Awesome Space Edu Film Beepers, Tweeters, & Peekers Edu Film Colors & Shapes Edu Film Deep Sea Dive Not Rated Edu Film Discover Spot in School Video Edu Film I'm Glad I'm Me Edu Film Learning about Letters Edu Film Learning about Numbers Edu Film Really Wild Animals: Swinging Safari Edu Film Rescue Heros Not Rated Edu Film See How They Grow: Insects & Spiders Edu Film Sesame Street: Talk*Read*Write Edu Film The Alphabet Game Edu Film The Kitty Kats Edu Film The Puppy Dogs Edu Film The Teddy Bears Edu Film The Very Hungry Caterpillar Not Rated There Goes an Airplane Ages 3-8 Edu Film Way Cool Creepy Crawlers Edu Film

Against the Crooked Sky Not Rated Edu Film Butter Cream Gang Not Rated Edu Film Butter Cream Gang: Secret to Treasure Mnt Not Rated Edu Film In Your Wildest Dreams Not Rated Edu Film On Our Own Not Rated Edu Film Seasons of the Heart Not Rated Edu Film Space Camp Not Rated Edu Film Split Infinity Not Rated Edu Film

The Argon Quest Edu Film The Rogue Stallion Edu Film The Little Princess Edu Film Windwalker PG Edu Film

Beethoven PG Beethoven's 2nd PG Chitty Chitty Bang Bang G ET PG Grizzly and the Treasure Not Rated Heidi Not Rated Home Alone 2 PG Hook PG Jumangi PG Kavik the Wolf Dog Not Rated Last of the Comanches Not Rated Lost in the Barrens Not Rated Lucy Hates to Leave/Move to the Country Not Rated Man from Snowy River PG Milo & Otis G Old Yeller G Rookie of the Year PG SideKicks PG Snowdogs PG Snowy River: The McGregor Saga Not Rated The Shaggy Dog G Where the Red Fern Grows Not Rated Cartoon Sing Alongs Not Rated Fantasia 2000 PG The Feel Better Friends w/ Rosenshontz & Pandy Fraggle Rock Not Rated It's A Dog's Life Ages 2-5 Edu Film Rappin' n Rhymin' Not Rated Rock with Barney Ages 2-8 Sesame Street: Play Along Games & Songs Edu Film Wiggle Time Not Rated Wiggles Yummy Yummy Ages 1-8

A Charlie Brown Thanksgiving Not Rated A Walt Disney Christmas Not Rated Alvin and the Chipmunks: Love Potion #9 Not Rated Berenstain Bears: Cupid's Surprise Cupid's Surprise Not Rated How the Grinch Stole Christmas Not Rated It's the Great Pumpkin Charlie Brown Not Rated Magic School Bus: Creepy, Crawly Fun! Peter Cottontail G Rudolph the Red Nosed Reindeer Not Rated Santa and the Three Bears Not Rated Scooby-Doo: Legend of the Vampire Not Rated Tales of the Tooth Fairies Hallmark Winnie the Pooh and Christmas Too Not Rated Winnie the Pooh: Frankenpooh Not Rated Winnie the Pooh: Seasons of Giving Not Rated Winnie the Pooh: Spookable Pooh Not Rated

Courage PBS for Kids Friendship PBS for Kids Generosity PBS for Kids Honesty PBS for Kids Responsibility PBS for Kids Self-Discipline PBS for Kids

The list above is provided to you so that you are aware of movies that may be viewed at Precious Hearts Learning Center, Inc. on occasion. The facility may also attend movies at the local movie theaters. We would like you to check the movies that you feel comfortable with your child viewing, and mark them as acceptable. Please note these movies may not be used in your child's class, but we want to cover any possible selections that we have available.

Child's Name Parent's Name

Date Special Needs Information and Care: Any child who receives treatments for asthma, allergies,

speech therapy, physical therapy, has an IEP, etc. needs to have this information on file, even if the

staff at the center does not need to administer any treatment for the condition during operating hours.

Child's Name:______Date of Birth:______

Is your child under the care of any specialist? Yes No

Type of care received: Speech Therapy Physical Therapy

Psychological Counseling Social Worker

Physician/Allergist Other______

Reason for seeking specialized care ______

Diagnosis ______

Treatment (including specific strategies for dealing with special needs) ______

If the child is to receive treatments during his/her scheduled hours at the center, how and by whom is this treatment to be administered? ______

Are there any symptoms, indications, cues, or possible problems relating to the child's condition or treatment that we should look for or be aware of? ______

Signature of physician/specialist:______Date:______

Parent(s)' Acknowledgement:______Date:______Precious Hearts Learning Center

Swimming Questions:

1. How would you rate your child as a swimmer?

a) Beginner b) Intermediate c) Advanced

2. What would you consider to be your child’s skin type in regards to sunburn?

a) Burns often b) Burns occasionally c) Burns rarely

The first day that the summer camp goes swimming, the teachers will put each child through a basic swimming test in the pool just to make sure who will need special attention in the water. If your child cannot swim well, PLEASE have him/her bring a lifejacket to wear at all times in the water. Sunscreen should be with the child at all times to help prevent sunburns.

Swimming Requirements: - Sunscreen, towel, swim wear, cool; comfortable clothes, bag for wet clothes - THIS IS THE ONLY TIME YOUR CHILD MAY WEAR SANDALS AT CAMP, AND SHOULD HAVE OTHER SHOES TO WEAR WHEN BACK AT PRECIOUS HEARTS

TRANSPORTATION:

I give permission for my child to depart from Precious Hearts Learning Center on the Precious Hearts Learning Center van, and to arrive back at Precious Hearts Learning Center on a regular basis. I also give permission for my child to participate in all planned activities outside the daycare setting.

CHILD’S NAME: ______PARENT’S NAME: ______DATE: ______New student informational checklist for parents to fill out

Admission Date______

Child’s full name______

Child’s birth-date______

Parent’s full name(s)______

Parent’s home & work #’s______

Allergies______

NEW STUDENT ORIENTATION CHECKLIST

Introduce child to teachers Select cubby and label with child's name Show child where to hang his/her coat Show child where the bathrooms are located Make sure cot sheet & blanket has been labeled Assign cot placement Make sure child's folder is present in clear file Make sure child's handprints & name are on the wall Make sure assessment form have been placed in an assessment file box _____ Make sure that the child has all the necessary supplies in their cubby

Date completed: ______Teacher of Child: ______Non-Prescription Topical Application Permission

I give permission for the following non-prescription topical treatments to be applied to my child on an as-needed basis in accordance with the directions listed on the packaging. I understand that only products I have provided will be applied to my child.

______Sunscreen (Please indicate brand): ______

______Insect repellent (Please indicate brand): ______

______Diapering Cream (Please indicate brand): ______

______Other: ______

______Child’s Name

______Parent Signature Date