Infant/Toddler Enrollment Packet
Thank you for your interest in Learning Hive Child Development Center. This packet contains all the paperwork needed to enroll your child in our program.
Registration Checklist
Enrollment Application_____ Parent Agreement with Learning Hive_____ Emergency Medical Authorization_____ External Preparations_____ Disciplinary Policy_____ Parent Handbook Agreement_____ Photography Release_____ Immunizations_____ Infant Feeding Plan______ Copies of Parent/Guardian ID_____ My child is enrolling in the following: Full Time Child Care Part Time Child Care Before/After School Extracurricular Club Activities (Cooking, Etiquette, Fitness etc) How did you hear about us? ____________________________________________________ After your childs paperwork has been received and you have met with the director, your child is on his/her way to being a Future Leader! Looking forward to a great year!
Learning Hive
Learning Hive accepts qualified children without regard to race, color, religion, national origin, economic status or sex.
FAMILY REGISTRATION FORM
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Entrance Date
Withdrawal Date
Childs Name_____________________________ Sex _____Age _____Birth date__________ Home Address(Street) __________________________________________________________ City_______________________ State ____________________ Zip_____________________ Home Phone __________________________Parent Email_____________________________ Fathers Name__________________________Telephone Number_______________________ Fathers Home Address (if different from Childs)Street________________________________ City___________________________ State______________ Zip________________________ Fathers Place of Employment______________________ Work Phone Number ____________ Employers Street Address____________________________ City_______ State____ Zip_____ Mothers Name_________________________ Telephone Number________________________ Mothers Home Address (If different form childs) Street _______________________________ City___________________________ State _____________________Zip__________________ Mothers Place of Employment ______________________Work Phone Number_____________ Employers Street Address____________________________ City____ State____ Zip________ Childs Living Arrangements:(check one) [ ] Both Parents [ ] Mother [ ] Father [ ] Other Childs Legal Guardian(s): (check one) [ ] Both Parents [ ] Mother [ ] Father [ ] Other
The child may be released to the person(s) signing this agreement or to the following: Name _____________________________Address(Street)______________________________ City____________________________ State_______________________ Zip_______________ Relationship to Parent/Guardian_______________ Relationship to Child___________________ Other Identifying information (if any) _______________________________________________ Name _____________________________Address(Street)______________________________ City____________________________ State_______________________ Zip_______________ Relationship to Parent/Guardian_______________ Relationship to Child___________________ Other Identifying information (if any) _______________________________________________
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Persons to contact in the case of an emergency when parents cannot be reached: Name____________________________ Telephone Number___________________________ Name____________________________ Telephone Number ___________________________ Name____________________________ Telephone Number___________________________ Name of public or private school child attends, if any__________________________________ PERSONS NOT AUTHORIZED TO PICK UP MY CHILD Name________________________ Address___________ ___________ (If applicable I will provide a copy of a court order or injunction stating that the person(s) named above may not pick up this child). Childs Physician or Clinics Name _________________________________________________ Doctor or Clinics Telephone Number_______________________________________________ My child has the following special need(s):___________________________________________ _____________________________________________________________________________ _ _____________________________________________________________________________ _ The following special accommodation(s) may be required to most effectively meet my childs need while at this center:__________________________________________________________ _____________________________________________________________________________ _ _____________________________________________________________________________ _
Emergency Medical Authorization
Should (Childs Name)___________________________________ Date of Birth ________________ suffer an injury or illness while in the care of Learning Hive and the facility is unable to contact me immediately, it shall be authorized to secure such medical attention and care for the child as may be necessary. I (we) shall assume responsibility for payment of services. The facility agrees to keep me informed of any incidents requiring professional medical attention involving my child.
Does your child have current immunizations? Please provide a copy of their immunization record. [ ] Yes [ ] No [ ] Immunization records attached Parent/Guardian Signature _________________________________Date ________________ Administrator Signature ___________________________________ Date________________
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Parental Agreements with Child Care Facility 1. Learning Hive agrees to provide child care for ________________________________ (Name of Child) on___________________ from ______ AM ____PM from _____________to _____________ (Days of Week) (month) (month) My tuition rate is $_________ per _________ My child will participate in the following meal plan (circle applicable meals and snacks): Breakfast Morning Snack Lunch Afternoon snack Supper Before any medication is dispensed to my child, I will provide a written authorization which includes: date, name of child, name of medication, prescription number, if any, dosage; date and time of day medication is to be given. Medicine will be in the original container with my childs name marked on it. My child will not be allowed to enter or leave the facility without being escorted by the parent(s), person authorized by parent(s), or facility personnel. I acknowledge it is my responsibility to keep my childs records current to reflect any significant changes as they occur, e.g. telephone numbers, work location, emergency contacts, childs physician, childs health status, and immunization records, etc. The facility agrees to keep me informed of any incidents, including illnesses, injuries, adverse reactions to medications, exposure to communicable diseases, which include my child. Learning Hive agrees to obtain written authorization from me before my child participates in routine transportation, field trips, special activities away from the facility, and water-related activities occurring in water that is more than two (2) feet deep. I authorize Learning Hive to obtain emergency medical care for my child when I am not availale. I have received a copy of the parent handbook and agree to abide by the policies and procedures for Learning Hive. I understand that the center will advise me of my childs progress and issues relating to my childs care as well as any individual practices concerning my childs special needs. I also understand that my participation is encouraged in facility activities.
FAMILY REGISTRATION FORM
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Signature (Parent/Guardian) ___________________________ Date________________ Signature (Facility Administrator)________________________ Date________________
External Preparations Form
Child __________________________________________Date_____________________ I hereby give Learning Hive permission to apply one or more of the following external preparations, in accordance with directions for use on container : Baby wipes Band-Aids Neosporin Bacitricin or similar ointment Bactine or similar first aid spray Non prescription ointment (such as A&D, Desitin, Vaseline) And Other items contained in First Aid Kit I release Learning Hive from any liability for administering these preparations.
Parent/Guardian Signature _____________________________Date__________________
Disciplinary Policy
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 of how children learn and develop values, Learning Hive will practice the following discipline and behavior management policy. Conflict Resolution skills will be encouraged. Children will be through to think through and resolve daily challenges with the support and instruction of program personnel. 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 to, after meeting with the parents and documenting behavior problems and interventions, terminate child care services for that particular child. The following procedures will be followed:
1. Verbal warning will be given. 2. Child will be removed from classroom if behavior is disruptive. 3. Child may be denied fun/special privileges (including off campus activities). A disciplinary notice of action will be sent home to the parent. 4. Learning Hive Director will request a meeting with the parent to discuss concern. 5. Learning Hive reserves the right to suspend or expel children from Learning Hive Child Development Center when it deems necessary.
FAMILY REGISTRATION FORM
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Parent /Guardian
Learning Hive Director
MEDIA RELEASE Dear Parents, We hope that your child enjoys Learning Hive. We are sure that they will have a lot to share with you over the course of the year. As we go through our fun filled days, we would like to make sure that we have your permission to include your child in the presentation and publications for the future. Please sign and date this form giving permission for your student(s) to be photographed by Learning Hive and its partners. MEDIA RELEASE I hereby give my consent to all photographs, audio recordings, or video recordings taken of me or my minor child by Learning Hive, staff, partners, or their designee. I understand that any such photographs, audio recordings, or video recordings become the property of Learning Hive and may be used by Learning Hive or others with their consent, for educational, instructional, or promotional purposes determined by Learning Hive. Yes, I give permission. No, I do not give permission. Childs Name_______________________________________________ Signature ______________________________Date________________
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Infant Feeding Plan Child's Name ______________________________________ Date _______________ Birthday__________________________________________ Does the child take a bottle? Yes [ ] No [ ] Is the bottle warmed? Yes [ ] No [ ] Does the child hold own bottle? Yes [ ] No [ ] Can the child feed self? Yes [ ] No [ ] Does the child eat: Strained Foods [ ] Whole Milk [ ] Baby Foods [ ] Table Food [ ] Formula [ ] Other [ ] What type of formula used?________________________________________________ Amount of formula to be given? ______________________________________________ Updated amounts of formula? _______________________________ Date ___________ ________________________________ Date ___________ ________________________________ Date ___________ Does the child take a pacifier? Yes [ ] No [ ] When?_____________________________________________________________________ Food likes ____________________________________ Food dislike_____________________ Allergies- including any premixed formula ___________________________________________
Child's Schedule Breakfast _________________________________________________________________ Approximate Time Types and approximate amount of food Lunch ___________________________________________________________________ Approximate Time Types and approximate amount of food Dinner ___________________________________________________________________ Approximate Time Types and approximate amount of food Morning Nap ___________________ Afternoon Nap________________________________ Approximate Time Approximate Time Instructions for the introduction of solid foods __________________________________
As needed, please list updated instructions regarding adding new foods or other dietary changes. __________________________________________________________________________ __________________________________________________________________________
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Parent/Guardian Signature _______________________ Providers Signature________________________
