child registration packet (infant/toddler; 6 weeks 2...

Executive Director: Jennifer House – Tax ID: 33-0627685

1465 Madison Ave.

El Cajon, CA 92019

(619) 442-4014

Licenses: 3766006610/376600030/

376600594

350 Prescott Ave

El Cajon, CA 92020

(619) 499-7524

Licenses: 376701437/376701438/

376701439

1268 N. Second St. and

1164 N. Second St.

El Cajon, CA 92021

(619) 442-1685

Licenses: 376700510/376701239

9748 Los Coches Rd. #12

Lakeside, CA 92040

(619) 561-1178

Licenses: 376700666/376700667/

376700668

8824 Cottonwood Ave.

Santee, CA 92071

(619) 457-0381

Licenses: 376701224/376701225

CHILD REGISTRATION PACKET (Infant/Toddler; 6 weeks – 2 years)

Child’s Name: Date of Birth:

Date Registered: Start Date:

Group/Room: Account Key:

Days Attending: M T W TH F Full Half

Hours:

Tuition per

week:

Alternative Payment Provider:

Required Forms:

□ Emergency Information

□ Consent for Medical Treatment

□ Parent/Center Contract

□ Enrollment Questionnaire Allergies to food or milk? Yes or No

□ Physician’s Report (circle one)

□ Immunization Record Please Bring In:

□ Parent Handbook ● Immunization Record

□ Sick Policy ● Fitted Crib Sheet and Blanket

□ Parent’s Rights Form ● Extra change of clothes

□ Child’s Rights Form ● Diapers and Wipes (if applicable)

□ Assessment Form ● Baby Formula (if applicable)

□ Blue Immunization Card

□ Photo Release

□ Automated Payment Form

□ Permission to apply Sunscreen Form

□ Rights of the Licensing Agency

□ Meal Plan Application/Meal Benefit Form/Formula Form

Registration fee

Paid on ______ $150 Summer Activity

Fee:

18 mos – 2 years $65.00

Parent/Center Contract

I, , agree to enroll my child, in Children’s

Choice Learning Connection beginning on .

__ 1. Tuition will be $ per week.

__ 2. Overtime charges are $1.00 per minute, per child, if child is left at the

center past 6 pm.

__ 3. Charges for returned payments are $30.00 per transaction. Once there are two returned

items, it will result in CASH ONLY payment basis.

__ 4. Tuition is due every Monday by 6 pm. If payment is not received by 6 pm, a late fee of

$25.00 will be assessed to my account. If tuition is not current by the end of the second

week, child may not return until tuition is paid in full, including all incurred late fees.

Many classrooms have waiting lists and your child’s spot might be filled if tuition is past

due.

__ 5. I am responsible for the FULL tuition amount regardless of missed day due to illnesses

or holidays.

__ 6. Children may be taken from the facility only by the persons that are specified on the

“Identification and Emergency Information” form.

__ 7. A paid two weeks’ notice is required before dropping my child(ren) from the program.

__ 8. In addition to the weekly tuition, a Summer Activity Fee will be due June 1st every

summer. The fee is $155 for school age or $65 for pre-school age.

__ 9. I have received a CCLC Parent Handbook. I also understand that I am responsible for

reading and asking any additional questions in reference to Children’s Choice’s policies

and procedures.

Parent Signature Date Director Signature Date

Sick Policies Dear Parents,

It is our goal to provide your child with the safest and healthiest environment. Children’s Choice

has taken positive steps towards this goal. We have enhanced our health policies to include

comprehensive hygiene and universal precaution practices which will help to reduce the spread of

illnesses.

We believe that Children’s Choice hygiene and universal precaution practices can make a

difference in creating a healthier environment. We will be monitoring our progress toward the

reduction of illness among children and staff. In order to obtain this goal, we will need your help

as follows:

❖ If your child does not feel well enough to attend the center, please call the center on your

child’s first day of absence.

❖ If your child is not feeling well, but is not ill enough to see a doctor, give us a description

of your child’s symptoms (stomachache, vomiting, fever, runny nose, diarrhea, etc.) when

you call.

❖ If you have seen a doctor, please tell the director the physician’s diagnosis when you call.

❖ When your child returns to the center, please update us on his or her condition.

Children will be excluded from the center, or you will be called to come pick them up for the

following reasons:

❖ FEVER: the child may not return until the fever is gone for 24 hours without medicine

❖ DIARRHEA: more than one loose, watery stool

❖ VOMITING: may not return until vomiting has stopped for 24 hours

❖ PINK EYE/EYE INFECTION: may return after using the drops for 24 hours

❖ RASHES: especially with a fever or itching

❖ SORE THROAT: especially with a fever or swollen glands

❖ CHICKEN POX: may return after all sores have scabs (usually 5-7 days)

❖ Too sick to participate, unusually tired, pale, lack of appetite, confused or cranky

Sick children will not be accepted at school, and we will strictly enforce these policies.

Children’s Choice policies for health and hygiene are the most comprehensive and progressive in

the field of childcare, and we sincerely believe that, as a result, our children and staff members

will experience fewer absence days due to illness.

We appreciate your cooperation and understanding.

Parent Signature Date

EMERGENCY INFORMATION

Child’s Name: Child’s Birth Date:

Address: Child’s Age: Sex:

City: St: ZIP: Home # ( )

Mother/Guardian’s Name: Cell # ( ) Provider (e.g. Verizon/AT&T etc,)

Mother/Guardian’s Employer: Work # ( )

Father/Guardian’s Name: Cell # ( ) Provider (e.g. Verizon/AT&T etc,)

Address:

City: St: ZIP: Home # ( )

Father/Guardian’s Employer: Work # ( )

Mother/Guardian’s primary email:

Father/Guardian’s primary email:

Persons Authorized to Pick up Child

1 ) Name: Relationship:

Address: Phone #

2 ) Name: Relationship:

Address: Phone #

3 ) Name: Relationship:

Address: Phone #

4) Name: Relationship:

Address: Phone # *PLEASE REMEMBER: All persons authorized to pick up your child MUST have a valid identification card with them in order for the child to be released.

PHOTO RELEASE

Yes, I hereby give Children’s Choice Learning Connection permission to

use my child’s photograph and likeness in all forms of media for

advertising, trade, and any other lawful purposes.

I attest that I am the parent/guardian of the child(ren) stated below.

I have read this release form and approve of its terms.

Child(ren) Name(s):

Parent/Guardian Printed Name:

Parent/Guardian Signature:

Date:

No, I, , do not give my permission for

my child’s photo to be used for any purposes.

Parent/Guardian Signature:

Date:

Infant Needs and Assessment Plan

Date: _______________

Next Assessment Due: _____________________

(To Be Updated Every 3 Months)

Child’s Name: _____________________________ Date of Birth: ____________________________

Mother’s Name: ___________________________ Daytime Phone: __________________________

Father’s Name: ____________________________ Daytime Phone: __________________________

Feedings:

Bottle ____ Cup _____ Type of Formula ______________ Does your child need to be burped? ______

Are there any feeding problems? If so, please describe: _______________________________________

Are there any food/liquid your child dislikes? Please list: Are there any food allergies? Please list:

_____________________________________________ _________________________________

_____________________________________________ _________________________________

_____________________________________________ _________________________________

Feeding Schedule: Fluids Schedule:

Type Amount Time Type Amount Time

__________ __________ __________ __________ __________ ________

__________ __________ __________ __________ __________ ________

__________ __________ __________ __________ __________ ________

__________ __________ __________ __________ __________ ________

__________ __________ __________ __________ __________ ________

Diapering:

Is your child prone to diaper rash? ___________________ How is it treated? ______________________

Sleeping:

Does your child need a special toy or blanket to sleep with? ___________________________________

Does your child need to be rocked to sleep? _________________________________________________

What is the best way to comfort your child? ________________________________________________

Please add any other information that will help us understand your child’s sleeping habits: ___________

Napping Schedule:

Morning Naptime: _______________________ Usual Bedtime: ____________________

Afternoon naptime: _______________________

Health:

Illness: Frequent Colds __________ Ear Infections _________________

Diarrhea _______________ Rashes _______________________

Pets at Home:

Dog __________ Cat __________ Fish __________ Other _____________________________

Other Caregivers:

Grandparents ___________________ Babysitter ___________ Other ______________________

Potty Training:

Parent and Staff Agreement:

1. At Children’s Choice, we will begin to train at child at 24 months old. It is agreed by the parents to be

consistent with the time to begin training.

2. Parents and staff will involve the toddler in taking down his/her own pants, zipping, and unbuttoning.

Parents will decide how we are to train males to urinate (will he hold penis and stand or sit and hold

penis down).

3. Parents will understand that the toddler will not immediately be able to wipe his/her own bottom after a

bowel movement. Staff will assist until skill is learned.

4. Staff will not force a child to sit on a toilet. Scolding will not take place. Trips to the potty will be short

and fun.

5. Staff will provide instruction and assistance in hand washing after toileting.

Parent Signature: ________________________________ Date: _______________________

Director Signature: _______________________________ Date: _______________________

Staff Signature: __________________________________ Date: _______________________

Permission

to apply

Sunscreen

I give permission for the staff at Children’s Choice Learning

Connection to apply sunscreen / sun block to my child. I

understand that Sunscreen / Sunblock cannot be shared with

other kids/staff.

PARENTS MUST PROVIDE SUNSCREEN / SUN BLOCK

Child’s Name:

Parent’s Signature:

_

For Official Use Only

Date Received

________________________

Employee Signature

________________________

A service of

Checking Savings

Copyright Procare Software 1/16/2015

We are excited to offer the safety, convenience and ease of Tuition Express®–a payment processing system that allows

secure, on-time tuition and fee payments to be made from either your bank account or credit card.

ELECTRONIC FUNDS TRANSFER AUTHORIZATION FOR BANK ACCOUNT and CREDIT CARD

I (we) hereby authorize (business name) ___Children’s Choice Learning Connection_____ to initiate credit card charges to the below-referenced credit card account (Section A) OR, initiate debit entries to my (our) checking or savings account, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. Credit union members: please contact your credit union to verify account and routing numbers for automatic payments. Check with the center for accepted credit card types. COMPLETE ONE SECTION ONLY

SECTION A (Credit Card)

__________________________________________________________________________________________________Cardholder Name Phone #

__________________________________________________________________________________________________Cardholder Address City State Zip

__________________________________________________________________________________________________Account Number Expiration Date CVV (3 digit code)

__________________________________________________________________________________________________Cardholder Signature Date

SECTION B (Bank Account) __________________________________________________________________________________________________Your Name Phone # __________________________________________________________________________________________________

Address City State Zip __________________________________________________________________________________________________Bank or Credit Union Name Bank or Credit Union Address City State Zip

__________________________________________________________________________________________________Routing Transit Number (see sample below) Account Number (see sample below)

__________________________________________________________________________________________________ Authorized Signature Date

Automated Payment Processing

Safe – Convenient – Easy

Rights of the Licensing Agency: Section 101200 (b) & (c)

The Department or Licensing Agency shall have the authority to interview children, or staff, and to inspect and

audit child or facility records without prior consent. The licensee shall make provisions for private interviews

with any children or staff members. The Department has the authority to inspect, audit, and copy child or

childcare center records upon demand during normal business hours. Records may be removed for copying if

necessary.

____________________________________________

Child’s Name

____________________________________________ ________________________________

Parent/Guardian Signature Date

____________________________________________ ________________________________

Center Director Signature Date

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