Enrollment packet preschool

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Enrollment packet preschool

  1. 1. Authorization and Permission Form for _______________________ (child’s name)I/We _____________________________________________, hereby grant permission to staff atAlif-Ba-Ta Learning Center toprovide the following activities for our child by initialing & signing below.1. I/We hereby grant permission for our child to use all of the indoor and outdoor play equipment and to participate inall of the activities of this program. ______2. I/We hereby grant permission for our child to sleep in a mat or cot provided. ______3. I/We hereby give permission for our child to leave the premises under the supervision of a responsible adult forpreschool walks and other scheduled and unscheduled excursions. Permission forms for each will be provided.______4. I/We understand that all field trip expenses are the parent’s responsibility and agree to this as it is stated in the policystatement of this program. I/We also understand that if a field trip will take place that the staff will give advancenotice and a separate permission form to be signed with the details of the trip. I also understand that if I choose formy child not to attend, that it is my responsibility keep the child out of the program for the day without tuitionreimbursement from the center for the fieldtrip. ______5. I/We give permission for our child to have sunscreen applied on exposed skin areas before going outside on sunnydays. Sunscreen is supplied by the parent/staff and applied per stated in the health policies handbook. ______6. I/We give permission for over the counter products and topical to be used on our child for preventative purposesincluding but not limited to skin lotion, diaper cream/ointments, Orajel, Neosporin, Chapstick, or ___________ and______________.7. InitialtoApproveInitialtoDeny I/We give permission for my child to participate in each of the following activities. Allmedia programs contain age-appropriate content (G or PG ratings) and will not containviolence, profanity or other inappropriate content.A TelevisionB VideoC Gaming systems (Educational Only)D ComputerNOTORIZED AUTHORIZATION FOREMERGENCY MEDICAL CAREI/We _______________________________________________, authorize staff at Alif-Ba-Ta Learning Center to call a doctor,911, or an ambulance for medical or surgical care for my/our child __________________________________ (child’s name),should an emergency arise. It is understood that a conscientious effort will be made to locate the parents/guardians beforeemergency action will be taken, but if this is not possible, the expenses of emergency medical treatment or care will beaccepted by the parents/guardians. Notarization is required annually to provide the program staff with authorization to givemedical authorization to emergency/health professionals:_______________________________________ _____________________Parent/Guardian Date_______________________________________ _____________________Parent/Guardian DateSubscribed and affirmed before me this ____________ day of ___________, 20__, in the County of__________________________, State of Colorado.______________________________________ My Commission Expires: _____________________________Notary Public
  2. 2. Child Release AuthorizationI understand that every effort will be made to contact me. In the event the staff is unable to reach me I authorize thefollowing designate(s) to pick up my child. I understand designate(s) must be over the age of 18 years and have avalid state issued driver’s license and an age appropriate vehicle child restraint. I will instruct my designate(s) tobring their I.D. with them each time they are needed to pick up my child. I also understand that any additions to myChild Release form must be done in writing prior to needing a new addition to pick my child up. I understandwithout written consent the staff cannot release my child to another person not listed.Child’s name: ________________________________________ DOB: _________________________The following persons are authorized to pick up my child:1stPersonName: Relationship:Address: Work/Home Phone:City/Zip: AlternateContact:2ndPersonName: Relationship:Address: Work/Home Phone:City/Zip: AlternateContact:3rdPersonName: Relationship:Address: Work/Home Phone:City/Zip: AlternateContact:4thPersonName: Relationship:Address: Work/Home Phone:City/Zip: AlternateContact:5thPersonName: Relationship:Address: Work/Home Phone:City/Zip: AlternateContact:_________________________________ _______________________________Parent/Guardian signature Date_________________________________ _______________________________Parent/Guardian signature Dat
  3. 3. PERMISSION TO PHOTOGRAPH FORMI, ________________________________________________________________________________________(parent’s or guardian’s name)give permission for Alif-Ba-Ta Learning Centerto photograph my child/ren, _____________________________________________________________(child’sname)for the following purposes:Type of Use:(Pleasecheckone)GrantPermission Decline PermissionStillPhotographs:Display in program’s scrapbook orbulletin boards, shown to current andprospective familiesDisplay still photos on center’s website *Use still photos in promotional materialsVideos:Display video on facility websiteUse videos in promotional materialsOther (pleaselist):* only first names and possibly last initials (in the event of two or more children with the same firstname) will be displayed on the facility website.I understand that it is my responsibility to update this form in the event that I no longer wish toauthorize one or more of the above uses. I agree that this form will remain in effect during theterm of my child’s enrollment. By signing below, I also agree that this is a legally binding form,and providing false information could be grounds for termination of the program’s services,forfeiture of retainer, or both.Father/Guardian’sSignature DateMother/Guardian’sSignature DateAlif-Ba-Ta Learning Center Date
  4. 4. PPERMISSION TO TRANSPORT AND FIELDTRIPSI HEREBY GRANT ALIF-BA-TA LEARNING CENTER PERMISSION TO TRANSPORT MY CHILD INLICENSED INSURED VEHICLES, USING FEDERAL APPROVED CHILD SAFETY SEATS AND BELTSACCORDING TO FEDERAL LAWS.I UNDERSTAND THAT MY CHILD IS BEING TRANSPORTED FOR THE FOLLOWING REASON(S):Field trips and emergency purposes.IF A FIELD TRIP IS SCHEDULED, I UNDERSTAND THAT I WILL BE GIVEN A SEPARATE FORM THATWILL NEED TO BE SIGNED WITH THE DETAILS OF THE FIELDTRIP, INCLUDING: DATE, TIME,LOCATION, AND COST.PARENTS SIGNATURE______________________________________ Date_________PROGRAM STAFF SIGNATURE______________________________________ Date_________
  5. 5. Program Transportation Release____ Check if Non Applicable to this childChild’s Name: ___________________________________________________________________Days Transportation Needed: M T W R FSchool Pick Up Time: ______________ School Drop Off Time: ______________I/we _____________________________________ have requested Alif-Ba-Ta Learning Center to transportmy child to the educational program.I/we understand it is my responsibility as the parent, to notify Alif-Ba-Ta Learning Center in advance andin writing of any changes in the need for transportation.I/we understand that if there is ever an issue with the program staff not being able to transport my child,that I will be given as much notice as possible, and it will become my responsibility to get my child to thecenter on those days.I/we understand that is my responsibility as a parent, to notify Alif-Ba-Ta Learning Center immediately inthe event that my child will not be riding to the center due to an illness/or otherwise.I/we, the undersigned parent(s)/guardian(s), do understand that center transportation is provided as a specialservice.I/we will not hold Alif-Ba-Ta Learning Center responsible for any problem that may arise due to weather,mechanical problems with the center vehicle, scheduling conflicts, etc.__________________________________ ___________________________________Parent/Guardian Parent/Guardian__________________________________ ___________________________________Date Date

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