enrollment packet preschool
Post on 07-Nov-2014
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Authorization and Permission Form for _______________________ (child’s name)I/We _____________________________________________, hereby grant permission to Yasmeen Nasira and Alina Mendoza of Alif-Ba-Ta Learning Center to provide 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 in all of the activities of this preschool program. ______
2. I/We hereby grant permission for our child to sleep in a nap room on a bed, mat or cot provided. ______3. I/We hereby give permission for our child to leave the preschool premises under the supervision of a responsible
adult for neighborhood walks and other scheduled and unscheduled excursions. Permission forms for each trip are not required. ______
4. I/We understand that all field trip expenses are the parent’s responsibility and agree to this as it is stated in the policy statement of this preschool program. I/We also understand that if a field trip will take place that the staff will give advance notice and a separate permission form to be signed with the details of the trip. I also understand that if I choose for my child not to attend, that it is my responsibility to find alternate care for that day without tuition reimbursement 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 sunny days. 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 purposes including but not limited to skin lotion, diaper cream/ointments, Orajel, Neosporin, Chapstick, or ___________ and ______________.
7. Parents will keep the provider informed of the foods being introduced. ______ 8. I/We give permission to work on potty-training my child once they are determined ready for this process. I
understand that a child seat will be used on a regular toilet if needed. ______
11. Initial toApprove
Initial to Deny
I/We give permission for my child to participate in each of the following activities for no more than 2 hours each day. All media programs contain age-appropriate content (G or PG ratings) and will not contain violence, profanity or other inappropriate content.
A TelevisionB VideoC Gaming systems (Educational Only)D Computer
I/We _______________________________________________, authorize Yasmeen Nasira and Alina Mendoza of 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 before emergency action will be taken, but if this is not possible, the expenses of emergency medical treatment or care will be accepted by the parents/guardians. Notarization is required annually to provide the childcare provider with authorization to give medical authorization to emergency/health professionals:
_______________________________________ _____________________Parent/Guardian Date_______________________________________ _____________________Parent/Guardian Date Subscribed and affirmed before me this ____________ day of ___________, 20__, in the County of __________________________, State of Colorado.
______________________________________Notary Public
My Commission Expires: _____________________________
Child Release Authorization
I understand that every effort will be made to contact me. In the event the staff is unable to reach me I authorize the following designate(s) to pick up my child. I understand designate(s) must be over the age of 18 years and have a valid state issued driver’s license and an age appropriate vehicle child restraint. I will instruct my designate(s) to bring their I.D. with them each time they are needed to pick up my child. I also understand that any additions to my Child Release form must be done in writing prior to needing a new addition to pick my child up. I understand without written consent the provider cannot release my child to another person not listed.
Child’s name: ________________________________________ DOB: _________________________
The following persons are authorized to pick up my child:
1st PersonName: Relationship:Address: Work/Home Phone:City/Zip: Alternate Contact:
2nd PersonName: Relationship:Address: Work/Home Phone:City/Zip: Alternate Contact:
3rd PersonName: Relationship:Address: Work/Home Phone:City/Zip: Alternate Contact:
4th PersonName: Relationship:Address: Work/Home Phone:City/Zip: Alternate Contact:
5th PersonName: Relationship:Address: Work/Home Phone:City/Zip: Alternate Contact:
_________________________________ _______________________________ Parent/Guardian signature Date
_________________________________ _______________________________ Parent/Guardian signature Date
PERMISSION TO PHOTOGRAPH FORM
I, ________________________________________________________________________________________ (parent’s or guardian’s name)
give permission for Alif-Ba-Ta Learning Center
to photograph my child/ren, _____________________________________________________________ (child’s name)
for the following purposes:
Type of Use:(Please check one)
Grant Permission Decline Permission
Still Photographs:Display in preschool’s scrapbook or bulletin boards, shown to current and prospective familiesDisplay still photos on center’s website *Use still photos in promotional materials
Videos:Display video on facility websiteUse videos in promotional materials
Other (please list):
* only first names and possibly last initials (in the event of two or more children with the same first name) 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 to authorize one or more of the above uses. I agree that this form will remain in effect during the term 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 preschool services, forfeiture of retainer, or both.
Father/Guardian’s Signature Date
Mother/Guardian’s Signature Date
Alif-Ba-Ta Learning Center Date
P
PERMISSION TO TRANSPORT AND FIELDTRIPS
I HEREBY GRANT MY PRESCHOOL PROVIDER PERMISSION TO TRANSPORT MY CHILD IN LICENSED INSURED VEHICLES, USING FEDERAL APPROVED CHILD SAFETY SEATS AND BELTS ACCORDING 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 THAT WILL NEED TO BE SIGNED WITH THE DETAILS OF THE FIELDTRIP, INCLUDING: DATE, TIME, LOCATION, AND COST.
PARENTS SIGNATURE
______________________________________ Date_________
PROVIDER SIGNATURE
______________________________________ Date_________
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