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GRACE DAYCARE INTAKE AGREEMENT
Hours of Operation Grace Day Care is open from 6:30 a.m. to 5:30 p.m. Program Description The program shall be designed to take into account the physical, social, emotional, and intellectual needs of the children within a Christian environment. Children in each class shall have access to learning centers regularly throughout the day. Caregivers serve as facilitators to enhance the children’s choices. Policy about Children Left After Closing Time Children are expected to be picked up by closing time. A charge will be assessed to any family picking a child up after closing time. If you cannot be reached, someone from your emergency contacts will be contacted. The late fee will be $1.00 per each minute late. (After 5:30) Emergency Medical Authorization I agree, and by my signature, give consent, that in any case of an accident, injury, or illness of a serious nature, my child will be given emergency medical care. I understand that I will be contacted immediately, or as soon as possible should I be away from the phone numbers given with this application. Sick Child Policy Children who are ill will not be allowed to attend the program. If your child becomes ill while at the center, you will be contacted to pick up your child. If you cannot be reached, someone from your emergency contacts will be contacted. Your child may not return to the center until he/she is symptom free and/or fever free for 24 hours. Field Trips and Excursions I give my permission for my child to participate in walking field trips or other excursions off the premises. Policy about Reporting Suspected Child Abuse Grace Day Care is required by law to report any suspected child abuse and/or neglect to Child Protective Services. Policy on Release of a Child to an Intoxicated or Impaired Person If an authorized person that the staff suspect is intoxicated or impaired insists on removing a child from the center, the staff will immediately report the incident to the local police agency. Discipline Policy Grace Day Care uses a positive disciplinary approach with children. Caregivers communicate to children using positive statements; encourage children, with adult support, to use their own words and solutions to resolve conflicts; and communicate with children at eye level and talk to them in a calm manner about what behavior is expected. Recurring disciplinary problems will be addressed with parents and documented in the child’s record.
Release Authorization for Children Children will be released only to a parent or a person named by the parent who has proper identification. Parents or persons named by the parent must make sure that a staff member is aware of the child’s arrival and departure. Parents shall sign the child in and out by name and time of arrival and departure. Meal Plan Breakfast will be offered to children who are in attendance at Grace Day Care before 8:00 a.m. A morning snack, lunch, and afternoon snack will be served daily. Parent Communication Parent-teacher conferences will be scheduled as needed or a parent may request such a conference at any time. In addition, teachers are always available for on-going communication and parents are always welcome at any and all times to observe our Intake Agreement, Cont’d. program. The center will forward to parents information provided by the licensing division regarding inclusion, rules, and other child care information. Unscheduled visits by a custodial parent or guardian are permitted at any time. Health Examination A health examination including immunizations is required for each child within 12 months prior to admission to Grace Day Care or within one month after admission on the forms provided. Child care services must be terminated if the provided health form is not returned within the above stated time period. Significant Occurrences or Problems You will be notified of any significant occurrences or problems which affect your child, including exposure to communicable diseases. Confidentiality Policy All information pertaining to admission, health, family, or discharge of a child is confidential.
___________________________________________________ Signature of Parent Date
INTAKE AGREEMENT Date of Admission________________________ Child’s Name_________________________________Nickname___________________ Date of Birth________________________Present Age________Sex________________ VERIFICATION DOCUMENT______________________________________ Home Address____________________________________________________________ Mother’s Name___________________________________________________________ Home Address_______________________________Home Phone__________________ Employer’s Name_________________________________________________________ Employer’s Address________________________Employer’s Phone________________ Work Hours_________________________ Additional Phone #s (cellular or beeper)_______________________________________ Father’s Name____________________________________________________________ Home Address_______________________________Home Phone__________________ Employer’s Name_________________________________________________________ Employer’s Address________________________Employer’s Phone________________ Work Hours_________________________ Additional Phone #s (cellular or beeper)_______________________________________
ADMISSION POLICIES Grace Day Care shall accept only children who are at a stage of growth and development which enables them to benefit from its program, and who for whose age level the center is staffed and equipped to provide care. Grace Day Care shall not admit or maintain any child whose needs it obviously cannot meet or whose behavior would be dangerous for other children in the center. Explicit, documented reasons for refusal to admit or provide care to a child shall be provided in written form to parents. There shall be no discrimination on the basis of race, color, religion, sex, national origin, or handicap. Name of person legally responsible for the center______________________________
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