little river child development center enrollment … enrollment packet.pdfwelcome to little river...

Little River Child

Development

Center Enrollment

Packet

Welcome to Little River Child Development Center! To provide you and your family with the best services, we

need the following information at enrollment:

Enrollment form with Copies of Photo ID

Items need for Enrollment

Service Agreement

Center Policies

Pick-up Authorization

Discipline Policy

Transportation/Walking Authorizations

Medical Information and Consent to Medical Care

Immunization Form

$50 Non-refundable registration fee

This facility participates in the USDA Child Care food program. The following forms must be completely filled

out prior to enrollment.

USDA Food Program/Income Eligibility Form (per family)

USDA Food Program Enrollment Form (per family)

USDA Food Program Medical Statement for Food Substitution

o Per child, if the child has any food allergies or food preferences.

CACFP Infant Feeding benefit Notification and Acknowledgement

o Per child, only infants (4 weeks-12 months)

The following information is available on our website, or please request a copy:

Tuition Schedule

Parent Handbook

Crisis and Disaster Handbook

You can find us on the web at: www.littlerivercdc.com. You can access our newsletters, upcoming events, and

lots of other useful information.

Thank you so much for your interest in Little River Child Development Center. We look forward to serving

you and your family soon!

Sincerely,

Amy Grogan, Director

Little River Child Development Center

3796 McDowell Lane

Little River, SC 29566

[email protected]

(843) 399-KIDS (5437) Phone

(843) 399-5549 Fax

http://www.littlerivercdc.com/

mailto:[email protected]

Enrollment Form

Name of Child: Date entered Care:

(First, Middle, Last)

Birth date: Nickname: Age of Entry:

Allergy Alert: Does tour child have allergies? Yes No To What?

Parent(s) or Guardian(s) Contact Information:

Name: Relationship:

Home address: Home Phone:

Employer/Worksite/hours: Work phone:

E-mail Address: Cell Phone:

Name: Relationship:

Home address: Home Phone:

Employer/Worksite/hours: Work phone:

E-mail Address: Cell Phone:

Other Children in the Household: Name/Nickname of child: Age: Sex:

Name/Nickname of child: Age: Sex:



We always try to contact parents first. However, we are required to have an emergency contact

OTHER THAN parents. These people are also authorized to pick up your child from the

facility. Please list all phone numbers appropriate: (These people will need to show photo ID before they will be

allowed to pick up your child.)

Name: Relationship:

Phone: / / /

Name: Relationship:

Phone: / / /

Name: Relationship:

Phone: / / /

Is there anyone who has a legal restraining order prohibiting or limiting contact with your child?

If yes, please list his/her name and attach the required documentation.

Name

Relationship to the child

Are there custody arrangements we need to be aware of?

Items Needed for Enrollment

Infants- (6 weeks- 1 year)

Diapers- Wipes- Bottles- Weather appropriate change of clothes

Please bring enough to leave at center so we do not run out;

no need to bring and leave a diaper bag.

Toddlers- (1 year-3 years) Diapers/Pull-ups- Wipes- Kinder Mat*- Body Pillow Case*-

(3) pair underpants (2 years and up)- Weather appropriate change of clothes

3 Years & Up Kinder Mat*- Body Pillow Case*- Weather Appropriate change of clothes

*Kinder Mats and Body Pillow Cases are required by DHEC. (2) King pillow cases will also work. We ask that

you bring the thinner red and blue Kinder Mats, as our cubbies are made to allow for these. Kinder Mats can

usually be found at Wal-Mart in the school supply section up on the top shelves.

Service Agreement



Birth date: Nickname: Age of Entry:

Parent’s or Guardian’s Name:


I hereby enroll and agree to pay for my child’s schedule and programs as listed below. I understand that I am

reserving this space for my child, agree to pay the fees set forth below for that space and understand that I

will NOT receive a refund when my child misses a day (i.e. for illness, vacation, etc.).

I understand that this agreement incorporates, and is subject to, the policies and procedures of Little River

Child Development Center, including all terms and conditions outlined in the Payment Policy, Crisis and

Disaster Handbook and the Parent Handbook.

Classroom: (circle) Infant Toddler Preschool Kindergarten After-School

Schedule: Monday Tuesday Wednesday Thursday Friday

Arrival

Departure

Programs/Fees: Cost: Registration Fee $50.00 (One Time; NON-REFUNDABLE)

Educational Program

• Ages Infant – 3 Years $140.00 per week

• Ages 3 Years – School Age $130.00 per week

Child Care

• School Age – When school is in session $60.00 per week

• School Age – When school is not in session $120.00 per week

Other Services

• Daily Drop-In Fee $30.00 per day

Transportation Fee

Not Applicable

Activity Fee

To be provided in writing to parents prior to activity.

School Year Enrollment Fee

Not Applicable

Other

Parent/Guardian Signature:

Date:

Center Policies

Payment- Child care tuition is due each MONDAY, for the following week or monthly in advance. If tuition has not been

paid by end of business on Monday your child will NOT be allowed back into the program until the tuition has been paid

along with any late fees. LRCDC requires a valid credit/debit card on file. This will only be used in the event you sign up

for Auto Pay as indicated below, or if you withdraw from the program leaving a balance with no written payment plan.

Credit Card #: __________________________________ Expiration Date: ___________________

If you wish to enroll in Auto Pay and have the above card charged for tuition every Monday initial here: _______

You will receive a $5.00 per week discount for enrolling in Auto Pay as long as the card is run without issues for that

week.

Returned Checks- There will be a $30.00 penalty for returned checks and a $20.00 late fee added to your account.

Late Pick-up Fees- There is a late fee of $2.00 per child per minute you are late. This is due if your child is picked up

after closing time. The late fee charge is due to the worker that is caring for your child at the time of pick-up. The fee

must be paid before your child is allowed to resume attendance.

Vacation- Available after 1 year date of enrollment- each child is allowed one week vacation per year (date of enrollment

to that date next year). Please give a one week notice that you will be using the following week as your paid vacation

week. Child cannot be present at LRCDC during this time.

Withdrawing from Center- A two-week written notice is required for all withdrawals, or 2 weeks full tuition is due.

Enrollment Fee- There is a one-time registration fee of $50, and is due at time of enrollment. This fee is non-refundable.

Illness- Full tuition is due for absence due to illness. There will be NO interruption of payment for illness, scheduled or

emergency closings or absence from the center. The center must be notified in the event you child contacts and contracts

a contagious illness. Alternative arrangements for child care must be made until the danger to other children has passed.

PLEASE NOTIFY THE CENTER WHEN YOUR CHILD WILL BE ABSENT.

Holidays- The center is open year-round. FULL TUITION IS DUE FOR SCHEDULED CLOSINGS. Rates have been

calculated to accommodate these closings.

Please initial here that you have received a copy of the closings for LRCDC: ________

Legal Fees- All legal & collection fees incurred in the collection of unpaid tuition is the responsibility of you, the client.

ABC Clients- You will be reminded 1 month prior to the expiration of your term. It is up to you to take the proper steps

in seeing that your term is extended. You are also responsible for the portion ABC does not pay, known as your co-pay,

under the same terms as above. If this is not paid not only will you be removed from the program, but ABC may

disconnect you from theirs and not allow you back on.


Date

Teacher of LRCDC Signature:

Date

LRCDC Owner or Director:

Date

Pick-up Authorization Form

The following people are authorized to pick up your child from the center in non-emergency situations - anyone

other than the listed people must be called in to the office to make us aware. Everyone will be asked to provide

a photo ID. These people may also be asked to tell us the code word that you provide below (not the same as

the computer code)

CODE WORD:

1) Name:

Description:

2) Name:

Description:

3) Name:

Description:

4) Name:

Description:

MEDICATIONS

All medications MUST be labeled with the child’s name and date. Medication Log must be filled out by

parent/guardian with signature and date, dosage, and time to be given daily. Prescription drugs and other

medications required by the child must be in the original container and clearly marked with the child’s name

and dosage schedule. By signing below, you understand the above statement and allow a LRCDC staff member

to administer daily ONLY the medications logged-in.


LRCDC Owner/Director Signature:

LITTLE RIVER CHILD DEVELOPMENT CENTER

DISCIPLINE POLICY

Policy Statement

Praise and positive reinforcement are effective methods of behavior management of children. When children

receive positive, nonviolent, and understanding interactions from adults and others, they develop good self-

concepts, problem solving abilities, and self-discipline. Based on this belief, Little River Child Development

Center uses a positive approach to discipline and practices the following discipline and behavior management

techniques.

WE DO

Communicate to children using positive statements.

Communicate with children on their level.

Talk with children in a calm, quiet manner.

Explain unacceptable behavior to children.

Give attention to children for positive behavior.

Praise and encourage the children.

Reason with and set limits for the children.

Apply rules consistently.

Model appropriate behavior.

Set up the classroom environment to prevent problems.

Provide alternatives and redirect children to acceptable activity.

Give children opportunities to make choices and solve problems.

Help children talk out problems and think of solutions.

Listen to children and respect the children’s needs, desires and feelings.

Provide appropriate words to help solve conflicts.

Use storybooks and discussion to work through common conflicts.

WE DO NOT

Inflict corporal punishment in any manner upon a child. (Corporal punishment is defined as the use of

physical force to the body as a discipline measure. Physical force to the body includes, but is not limited to,

spanking, hitting, shaking, biting, pinching, pushing, pulling or slapping.)

Use any strategy that hurts, shames, or belittles a child.

Use any strategy that threatens, intimidates, or forces a child.

Use food as a form of reward or punishment.

Use or withhold physical activity as a punishment.

Shame or punish a child if a bathroom accident occurs.

Embarrass any child in front of others.

Compare children.

Place children in a locked and/or dark room.

Leave any child alone, unattended or without supervision.

Allow discipline of a child by other children.

Criticize, make fun of, or otherwise belittle a child’s parents, families, or ethnic groups.

Conferences will be scheduled with parents if particular disciplinary problems occur. If a child’s behavior

consistently endangers the safety of the children around him/her, then the Director has the right, after meeting

with the parents and documenting behavior problems and interventions, to terminate child care services for that

particular child.

Note: If, at any point, there is an indication/suspicion that a child may have special needs, Little River Child

Development Center will inform the child’s family and help them make contact with Baby Net for assessment

and assistance.

My signature below indicates that I have received a copy of the discipline policy, it has been reviewed with me,

and I have read and understand this policy.

Signature _______________________________________________ Date __________________

Please circle as appropriate: STAFF PARENT

If parent, name of child _________________________________________

Transportation/Walking Release and Request

Child’s Name (please print):

Parents (Guardian Name):

Phone:

This serves as written acknowledgement that Little River Child Development Center will be making special

arrangements (such as school bus, child care facility vehicle or walking) for a child that arrives/leaves without a

parent. I am the parent or legal guardian of the above named child. I hereby release and agree to indemnify,

defend and hold harmless Little River Child Development Center, and their officers, agents and employees from

and against any and all claims, liabilities, actions, judgments, damages, and injuries of any kind and nature

whatsoever arising out of or in connection with the provision of transportation for my child according to the

authorized schedule.

Transportation Policy

1. We will not provide transportation to/from Little River Child Development Center and the child’s school.

2. We will not provide transportation to/from home.

Transportation/Walking Release and Request

Child’s Name (Please Print):

Field trips and Walking excursions: (please initial)

I authorize my child to be taken on:

Field trips or other extra-curricular activities by LRCDC Bus only

Walking excursions

Water Play

My child may participate in water activities other than swimming (ie. sprinklers, etc.) under required

supervision

My child may participate in swimming and other water activities under required supervision at the

Center only.

My child may participate in swimming and other water activities under required supervision at the

Center and off-site.

Signature of Parent/Guardian Print Name Date

My signature below gives permission for the following:

In an emergency Little River Child Development Center has my permission to call an ambulance or to take my

child to any available physician or hospital at my expense and to obtain medical treatment for my child. In

most emergencies, the child is transported to nearest hospital and seen by the Doctor on call. (Parents are

always notified as soon as possible).

My child may be given sunscreen, bug spray, anti-bacterial first aid cream and diaper ointment, as needed.

Syrup of Ipecac may be administered if deemed necessary by the poison control operator. (All medications

must be current and require permission slips for each medication).

I, «ParentGuardian_Name_1» «ParentGuardian_Name_2» (the natural parent or legal guardian), hereby give

permission that my child, «Childs_First» «Childs_Middle» «Childs_Last», may be given emergency treatment

to include First Aid and/or CPR by a qualified child care staff member at Little River Child Development

Center. I further authorize and consent medical, surgical, and hospital care, treatment and procedures to be

performed for my child by my child’s regular physician, or when that physician cannot be reached, by a

licensed physician or hospital, when deemed immediately necessary or advisable by a physician to safeguard

my child’s health and I cannot be contacted. I waive my right of informed consent for such treatment.

I also give my permission for my child to be transported by personal vehicle, ambulance or aid car to an

emergency center for treatment.

Emergency Phone Numbers: (Where Parent/Guardian can be reached, listed in order)

1. Number: Location: Ask for:





Signature of Parent/Guardian Date

Print Name

Medical Information



Birthdate: Nickname: Age of Entry:

Address:

Medical Information:

Medical Provider: Phone:

Address:

Child’s Dentist: Phone:

Address:

Preferred Emergency Center

Date of last physical exam?: Last Tetanus shot? Blood type:

Allergies: Does your child have any diagnosed allergies? (please circle) Yes No

If yes, please list all allergies:

Does your child have a plan of treatment for allergies? (please circle)** Yes No

Describe

Disabilities: Does your child have any diagnosed disabilities? (please circle) Yes No

If yes, please describe:

Does your child have a plan of treatment for their disabilities? (please circle)** Yes No

Describe **If your child has a plan for an allergy or a disability we must have a copy of the plan signed by their physician on file before we may

provide care.**

Medications: Does your child take any prescription medications? (please circle) Yes No

If yes, please list name of medication and dosage your child takes (including any medication

taken only at home):

**Medications must be current, have your child’s name on it clearly and require a signed and dated “Medication Administration” Form

or a prescription signed by your physician.**

Other pertinent Information/ Special Requests:

If your child has a special diet that is not to a medical reason, please describe:

Health Insurance Company:

Policy/group Number:

Policy Holder: Policy Holder’s SS#:


Date:

LITTLE RIVER CHILD DEVELOPMENT CENTER

PRIVACY PERMISSION AGREEMENT

Our first priority is to protect your family’s health and safety. To ensure that we are operating with your full

understanding and agreement about your privacy, we ask that you grant permission to conduct the following

activities. Please check off each item to which you give your consent, and sign below:

Placing photos of you, your spouse or co-parent and your children around the center.

Giving copies of photos of you, your spouse or co-parent and your children taken at the facility to

families in our care.

Placing photos of you, your spouse or co-parent and your children in photo albums for viewing by

prospective clients and families in our care.

Using photos of you, your spouse or co-parent and your children in our marketing flyers.

Using photos of you, your spouse or co-parent and your children on our Website and social media.

Posting artwork and other crafts that include your children’s names around our center.

Using an electronic monitor to watch and listen to you, your spouse or co-parent and your children

from another room while on the premises.

Listing you, your spouse or co-parent and your children’s names in our client newsletter and posting

this information on our bulletin board.

Parent/Guardian signature Date of signature

South Carolina Department of Social Services Child Care Regulatory Services

GENERAL RECORD AND STATEMENT OF CHILD’S HEALTH FOR ADMISSION TO CHILD CARE FACILITY

This form is to be completed for each child at the time of enrollment in the child care facility, updated as needed when changes occur, and maintained on file at the facility.

GENERAL INFORMATION: (to completed by Parent or Guardian) Name of Facility: Little River Child Development Center County: Horry

Address: 3796 McDowell Ln. Little River, SC 29566 Street Address- no Post Office Boxes City, State, Zip

Child’s Name:

Last First Middle Initial Nick Name

Date of Birth: Enrollment Date:

Child’s Current Home Address: Street Address City, State, Zip

Parent/Guardian’s Full Name:

Home Phone: Work Phone: Other Phone:

Parent/Guardian’s Full Name:

Home Phone: Work Phone: Other Phone:

You must have two individuals who have the authority to obtain emergency medical treatment for the child. 1. Person responsible if parent/guardian is unavailable for emergency medical services:

Full Name Relationship

Address: Street Address City, State, Zip

Telephone Number(s): Family Code Word(s):

2. Person responsible if parent/guardian is unavailable for emergency medical services:

Full Name Relationship

Address: Street Address City, State, Zip

Telephone Number(s): Family Code Word(s):

Is Child currently enrolled in school? (5K up to 6 years old) Yes No My Child will regularly attend this facility FROM am/pm TO am/pm

If Child is a drop-in, indicate hours of care: FROM am/pm TO am/pm

Check all days Child will regularly attend this facility: Mon Tue Wed Thurs Fri Check all meals Child will receive daily: Meals are not offered Breakfast Morning Snack Lunch Afternoon Snack Dinner Evening Snack

HEALTH INFORMATION: (to be completed by Parent or Guardian) Family Physician or Health Resource:

Name

Street Address City, State, Zip Telephone

DSS Form 2900 (MAR 10) Edition of OCT 07 is obsolete.

Emergency Care Provider:

Emergency Facility Name


Dental Care Provider: Name


Health Insurance Immunization: Yes No N/A Please Explain:

My child has the following health conditions such as allergies, asthma, diabetes, epilepsy, etc., and/or takes the following medications on a regular basis:

Additional Comments:

I certify to the best of my knowledge

Child’s Name

is in good mental and physical health and able to participate in the child care program at Little River Child Development Center.

Name of Child Care Facility

Signature:

Date:

Parent/Guardian Signature

Signature:

Date:

Director/Operator/Staff Designee

I hereby release and agree to indemnify, defend and hold harmless Little River Child Development Center,

and their officers, agents, employees and affiliated businesses from and against any and all claims, liabilities,

actions, judgments, damages and injuries of any kind and nature whatsoever arising out of or in connection

with the provision of child care and educational services for my child including all releases signed throughout

the enrollment paperwork.


Date:

little river child development center enrollment … enrollment packet.pdfwelcome to little river...

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