Child Application Form CHILD INFORMATION

Home , Rising Star (franchise)

Rising Star Academy, LLC. 825 E. Sheridan Street, Olathe, KS 66061 Phone: 913-709-3137 www.rising-star-academy.com [email protected] facebook: risingstaracademyolathe

Date of Application: ______Start Date: ______Termination Date: ______

Child Application Form CHILD INFORMATION:

Child’s Name: ______

Address: ______

Names and ages of other children in family: ______

PARENT INFORMATION:

Mother’s Name: ______Place of Employment: ______

Cell #: ______Work #: ______

Father’s Name: ______Place of Employment: ______

Cell #: ______Work #: ______

FAMILY STATUS: Married Separated Single

EMERGENCY CONTACTS:

Name: ______Phone #: ______Relationship: ______

Please list any special needs that may affect the child while in care:

TUITION AND ENROLLMENT:

Weekly Fee: $______Enrollment Fee: $______

PARENT/GUARDIAN SIGNATURE: ______DATE: ______

CCL.026 Kansas Department of Health and Environment Rev. 5/2017 Bureau of Family Health Child Care Licensing Program 1000 SW Jackson, Suite 200 Topeka, KS 66612-1274 Phone: 785-296-1270 Fax: 785-559-4244 Website: www.kdheks.gov/kidsnet

Authorization for Dispensing Medications to Children and Youth Short-Term Medications (Prescription and Non-Prescription)

Prescription medication must be in their original containers labeled with the child’s/youth’s first and last name; the name of the licensed physician, physician assistant (PA), or advanced practice registered nurse (APRN) who ordered the medication; the date the prescription was filled; the expiration date of the medication; and specific, legible instructions for administration and storage of the medication. Administer the medication only to the child/youth designated on the prescription label in accordance with the instructions on the label. Non-prescription medications can be given with written permission and direction from the parent or legal guardian. Administer nonprescription medication from the original container labeled with the first and last name of the child/youth and according to the instructions on the label. Medication #1 Medication #2

______First and Last Name of Child/Youth Date of Birth First and Last Name of Child/Youth Date of Birth ______Name of Medication Name of Medication ______Reason for Medication Reason for Medication ______Dose Time to be Given Stop Date Dose Time to be Given Stop Date

______Name of Licensed Physician/PA/APRN prescribing Name of Licensed Physician/PA/APRN prescribing the medication the medication (______)______(______)______Phone Number of Physician, PA, or APRN Phone Number of Physician, PA or APRN

I allow the above medication to be given to my child/youth I allow the above medication to be given to my child/youth by the designated person. by the designated person.

______Parent’s Signature Date Parent’s Signature Date

THIS FORM IS TO BE USED TO DOCUMENT ADMINISTRATION OF ONLY THE MEDICATION(S) IDENTIFIED ABOVE. Designated Person to note any comments or remarks about the child’s/youth’s appearance on the back of this form.

Date Time Name of Medication *Initials Date Time Name of Medication *Initials mm/dd/yy mm/dd/yy

*Each designated person administering medication is to sign on the back side of this form and identify initials used above.

*Signature of Designated Person Administering Medication ______Initialing as______

Note Form

Date Additional comments about the incident or other related incidents, including comments or remarks about the child’s/youth’s appearance and/or condition.

Rising Star Academy, LLC. 825 E. Sheridan Street, Olathe, KS 66061 Phone: 913-709-3137 www.rising-star-academy.com [email protected] facebook: risingstaracademyolathe

Authorization for Credit Card Use

PRINT AND COMPLETE THIS AUTHORIZATION AND RETURN. All information will remain confidential

Child’s Full Name: ______

Child’s Date of Birth: ______

Name on Card: ______

Billing Address: ______

______

Email: ______

Phone #: ______

Credit Care Type: Visa Master Card

Credit Card #: ______

Expiration Date: ______

Card Identification #: ______

Amount to Charge ($): ______

I authorize Rising Star Academy, LLC to charge the amount listed above every Monday to the credit card provided herein. I agree to pay for this purchase in accordance with the issuing bank cardholder agreement. I understand that if credit card is declined or payment is not received by Wednesday of same week than Rising Star Academy has the authority to stop providing child care service on Thursday of same week.

Please sign below:

Signature: ______

Date: ______

Print Name: ______Rising Star Academy, LLC. 825 E. Sheridan Street, Olathe, KS 66061 Phone: 913-709-3137 www.rising-star-academy.com [email protected] facebook: risingstaracademyolathe

EMERGENCY CONTACTS

Child’s Name: ______DOB:______

Mother’s Name: ______

Cell Number: ______

Work Number:______

Father’s Name: ______

Cell Number: ______

Work Number: ______

Emergency Hospital Refeerence: ______

Emergency Contacts:

Name: ______Phone #:______

Name: ______Phone #:______Tuition  12 months – 2 ½ years o $200.00/week for full-time o $180.00/week for 4 days a week o $50.00/day for drop-in care

 2 ½ years – 4 years o $185.00/week for full-time o $160.00/week for 4 days a week o $40.00/day for drop-in care

 4 years – 12 years o $175.00/week for full-time o $160.00/week for 4 days a week o $40.00/day for drop-in care

 Preschool (9:00 AM – 11:30 AM) o $80/week for full-time o $60/week for 3 days a week

Stretch-n Grow is included in above tuition (Once a week for 30 minutes)

 Before/After School Care (includes transportation) o $100/week

 Spring Break/Summer Break Activity Fees (school age) o These fees are due at the beginning of each month and will be based upon the field trip costs for that month.

825 E. Sheridan Street Olathe, KS 66061 913-709-3137 www.rising-star-academy.com [email protected] Facebook: risingstaracademyolathe

Parent Contract June 2020 About Us

Rising Star Academy, LLC in Olathe, KS is establish in November 2019. We strives to make a true difference in the way child care is offered. We want the friendly, homeliness of an in-home center, but being held to the standards of a center. Our current staff must meet the highest expectations of a teacher. We run our center with love, compassion and on a basis of child-led learning, to engage every single person and provide the best care possible. In addition to the owner(s) who strive to be actively involved, we also have a program director.

Hours of Operation

Rising Star Academy is open from 7:00 AM – 6:00 PM Monday through Friday. A late fee of $1/per minute is assessed for pickups past 6:00 PM. Rising Star Academy observes the following holidays and will be closed:

 New Year’s Day  Memorial Day  Fourth of July  Labor Day  Thanksgiving Day  Day after Thanksgiving  Christmas Eve  Christmas Day  New Year’s Eve (early closing)

If a holiday falls on a Saturday, we will be closed the Friday before. If a holiday falls on a Sunday, we will be closed the following Monday. If there is extreme inclement weather, the centers may be closed on a case by case situation. If employees are unable to make it to the center safely, the center may be closed. In case of other emergency that requires the center to be closed early or for additional days such as loss of power, water, heat/AC etc. the director will call and alert parents for immediate pickup. There may be additional closings throughout the year, with advanced notice to the families.

Pickup and Drop Off

Children are required to be escorted into and from the building at all times. When a child is dropped off, a staff member will sign them in. When a child is picked up, a staff member will sign them out. Please let us know as soon as possible if a child will not be attending that day. This is to ensure the child’s safety. Only persons on the authorized pickup list will be allowed to pick up the child and they will be asked to provide identification. In an emergency situation, the director may authorize a one-time authorization for a pick up not on the list through a phone call or email from the parent. If you wish to add or remove a person from the authorized pick up list, please let the director know.

Tuition

Tuition is due on the Monday for the upcoming week. If tuition is not received by Wednesday, Rising Star Academy has the authority to stop providing service from Thursday of same week or charge a late fee of $10 for every day past due. If a tuition statement consistently has a balance and a payment cannot be worked out, the child will be asked the leave the center until payment can be remitted and/or the balance will be sent to collections. An enrollment fee is due at the time of enrollment to reserve a spot, as well as due annually every September following. We offer one week of vacation to every family per year where tuition will be billed at half rate. Please let the director know ahead of time when you plan to use your vacation week. The child must not be present the entire week to receive the discount.

Attendance

Please let us know if your child will not be in attendance on a regularly scheduled day! Your child’s safety is of utmost important to us. We take the well-being of every child seriously and want to make sure all of our children are accounted for daily.

Termination of Care

A 2-week notice is required for termination of care. Failure to provide such notice will result in being billed for the 2 weeks, whether or not the child is in attendance. We understand that starting a new center is a big transition for a child. If the child is not adjusting after an extended period of time, a conference may be called with the parents to discuss a plan of action. If care is terminated on part of the provider, a two week notice is not given and therefore, not billed. For a child with behavioral issues, please see the child disciplinary policy. We are non-discriminatory in all of our policies.

Daily Schedule

All classrooms have a daily schedule posted. A structured schedule is crucial for children to feel comfortable and adjust to their daily routine. Daily activities include, but are not limited to, small/large group activities, centers, arts and crafts, story time, outside play, quiet time (nap) and free play. We provide a morning snack, lunch and an afternoon snack daily. We do not provide breakfast; however, we are happy to store cereal, breakfast bars, frozen waffles etc. and heat them up as you arrive in the mornings. Weekly meal plans are posted on the bulletin board in the front room. We begin preschool time at 9AM, so it is encouraged to drop off before then if possible. If you have any questions regarding the daily schedule, please contact your child’s teacher.

Food Allergies

We take food allergies extremely seriously. If your child has a food allergy, please ensure that a food allergy form is completed for their file. This also includes having a doctor’s note for the food allergy, which may be completed on the child health assessment form! For additional restrictions not necessarily allergy based and not requiring a doctor’s note, such as they require special milk such as soy, almond, or lactose free, it must be provided by the parent. If your child requires an epi-pen, a FARE plan of action is required to be on file and signed by a physician. All epi-pens will be locked up at all times.

Transportation

We currently bus to three elementary schools for before and after: Havencroft, Ridgeview and Mahaffie (after school only). Our morning bus leaves at 7:45AM so drop offs must take place before that time. We are typically back from afternoon bus run around or shortly after 4:00, so please be aware of that time as well when picking up. If you are interested in transportation to or from school, please speak with the director. During summer, winter and spring breaks, our school age children will take field trips accompanied by the director. During the summer only, our pre-k will join our school age children on occasional field trips. All children are required to wear seatbelts in the vans during transport. Under no circumstance will children attending Rising Star Academy be allowed to ride in the front seat.

Child Disciplinary Policy

The ultimate goal of Rising Star Academy discipline is self-discipline, self-control and self-direction. Our goals in caring for our daycare children include directing their behavior with words and by example, so that they will learn the skills necessary to control their own behavior and cooperate with others. Rising Star Academy focuses on prevention. It is our intention to try to prevent many behavior problems by providing direct supervision and guidance, age appropriate activities, love and interaction, a daily routine, and clear boundaries. If a child is posing a serious threat to themselves, other children, or teachers, the director shall first be notified and then parents called immediately for pick up. Our first priority is maintaining a safe environment for the children at all times. A child who is causing a disruption in the classroom will be always first and foremost be redirected. If he behavior continues, the child may be removed from the group for no more than a period of 1 minute per age of the child. If the behavior continues to be an issue, a conference with the parents may be scheduled. Behavior problems that cannot be resolved will result in termination of care. If you have any questions regarding the disciplinary policy, please speak with the director.

Diapering and Potty Training

All children who are still in diapers or pullups are required to supply their own diapers/pull ups and wipes. If diaper cream is needed, that is also to be supplied by the family. Any child not completely potty trained is required to have at minimum 2 full changes of clothes (shirt, underwear, pants, socks) and in the summer will be required to have swim diapers on hand. Please be aware of the seasons changing and the need to swap out clothes for changes in the weather. Once a child is ready to begin potty training, and at the discretion of their parent, we will begin the transition here. All children will begin potty training once they enter the potty training room at their center. We highly encourage parents to speak with their child’s teacher about potty training habits to ensure a smooth center to home transition in potty training. We also highly encourage mimicking routines done at home in the center.

Illness

All illnesses should be reported to the director, even if they did not occur while here. This helps us stop the spread of illness and keep our children safe. Children will be sent home and are to stay home for any of these conditions:

Temperature >101 Symptoms and possible illness (uncontrolled coughing, wheezing, lethargy, persistent crying, refusal to eat) Uncontrolled diarrhea (more than 3x in a day) Vomiting Sores on the mouth Blisters or sores on other parts of the body Rash with fever or heavier change Conjunctivitis or other eye drainage Other contagious diseases while in the communicable stage

A child must be symptom free for at least 24 hours without medication to return to the center.

Social Media

Rising Star Academy will post pictures and updates from the individual classrooms on their respective Facebook pages. This requires prior authorization from parents to have pictures taken and posted. Pictures will never accompany any additional identifying information of the child (I.E. name).

Fraternization Outside of the Center

While we highly encourage parents and staff to build relationships that encourage communication and allow the parents to feel safe with their child in care, it is prohibited for any employee to babysit, nanny or provide any other child care service to a child currently enrolled. Failure to abide by this policy may result in termination of care.

Medication Authorization and Administration

A child may only receive medication if a signed medication authorization form is on file. For non OTC medications, medication must be sent in the original container, labeled with the child’s name, birthday and dosage. Parents must indicate a start date and end date, as well as reason for the medication.

Medications will be stored in a locked box in the refrigerator or in a locked high cabinet (non-refrigerated medications) while in use at Rising Star Academy. The medication authorization form must remain with the medication at all times. Unused medications will be immediately returned to the family and will not be stored. Medications will only be administered Lead Teachers or the Director. When a medication is given, the teacher will document the type of medication administered, the dosage, and the time it was given as well as any unusual reactions or circumstances.

Documentation of Accidents

Staff members will document accidents and incidents that occur at Rising Star Academy using an Accident/Incident Report. A copy of the accident report will be sent home with the parent and the original will be kept in the child’s file. If the injury is serious, parents will be alerted immediately.

Additional Requirements

• Bedding is to be provided by the parent (sheet and blanket). Bedding with be laundered at the center after 5 sleeps. Please remember to write your child’s name on everything! • Toothbrushes will be provided. Children will practice brushing their teeth after meals. If a particular toothbrush is needed, it will need to be supplied by the parent. • Shoes without backs are not allowed. We encourage children to run, play and explore, and these types of shoes present a trip hazard. • If sending a girl child in a dress or skirt, please have shorts on underneath! • Please do not send toys from home, with the exception of show-n-tell days. Rising Star Academy is not responsible for lost or damaged items brought from home. • If a child will be in care for the summer, each child must have a swim suit, towel and sunscreen. We encourage parents to bring in extra sunscreen, as we frequently apply during the warm months. • If you would like to bring in treats for a birthday, holiday or other celebration, please give the staff or director advance notice if possible. We do have a small number of children with food allergies and we would like to get a substitute food item if possible! • We have an open-door policy! Parents are allowed to drop in to see the center and their child at any time. We discourage (but still completely allow) drop ins during nap time as it will disturb the other napping children. • We post pictures and class updates on our respective Facebook pages! Please ensure that your photo authorization form is complete to authorize pictures to be posted. • All paperwork must be completed prior to care beginning! Immunizations are to be updated annually. If there are any changes to your child’s paperwork, including pick up authorizations or emergency contacts, please let the director know.

I have read the parent handbook and will abide by all the policies listed. Failure to abide by the rules and regulations in this handbook.

Child Name: ______Parent Name: ______

Parent Signature: ______Date: ______

Provider Signature: ______Date: ______