Test

Enrolling Parent/Guardian Information

Full Name(Required)

First Middle Last

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary Phone(Required)

Secondary Phone

Tertiary Phone

Mobile Carrier(Required)

Email(Required)

Employer(Required)

Work Address(Required)

Street Address Address Line 2 City State ZIP Code

Child Information

Full Name	Sex	Date of Birth	Date of Enrollment	Actions

There are no Children.

Authorizations

Authorization For Emergency Medical and First Aid

I hereby authorize the staff and Director, representing Quality Care Child Development Center Inc. to give consent and all necessary emergency medial and First Aid case for my child(ren) while my child(ren) is in Quality Care Child Development Center Inc.'s custody.

Photography Permission

I give permission for my child(ren) to be included in Quality Care Development Center Inc. photography for publicity purposes.

Field Trip Transportation Consent

I give permission for my child(ren) to be transported by Quality Care Child Development Center Inc. on any and all field trips taken by the center.

Transportation Consent to and/or from School

I give permission for my child(ren) to ride the Quality Care Child Development Center's van or bus to/from school.

Name of Child(ren) & their Elementary School(Required)

First Name

Last Name

Elementary School

Does your child(ren) need to be delivered to or picked up from school?(Required)

Delivered to school

Picked up from school

What time does your child(ren) need to be delivered to school?(Required)

:

What time does your child(ren) need to be picked up from school?(Required)

:

Child(ren) Name(Required)

First Name

Last Name

Parent/Guardian Signature(Required)

Date

Financial Agreement

This is an agreement between the child's parent/guardian and Quality Care CDC. Quality Care CDC agrees to provide a class position in the center for each or your children enrolled in the center. The initial rate of tuition will be outlined below. Both parties understand that the tuition being charged may be changed as the child/children change, classes or as tuition is adjusted with a prior 30 day notice.

Financial Agreements & Terms of the Agreements(Required)

I acknowledge that I have read and understand each of the financial agreements.

1) All tuition is due regardless of attendance. This includes closing for holidays and inclement weather. All children not in attendance for one week with tuition unpaid will be considered dropped from enrollment and will be replaced with someone from the waiting list. Any child withdrawn for less than 30 days and wishes to re-enroll will be charged a $100.00 enrollment fee per child. If your child has a birthday and it now qualifies you for a lower tuition rate. The tuition rate will be adjusted for the week after the week after your child’s birthday.

2) Activity fees are charged in addition to the weekly tuition during the summer months, as well as spring break, Christmas break and inter-session for year-round schools. Activity fees range from $5.00 - $20.00 which are due at the beginning of each month.

3) In addition to the above, it is agreed that the weekly charges are due, and will be paid in advance. The weekly charges are due on or before 6:00 p.m. Monday of each week. Co-payments for DHS Subsidy are due on or before the 1st day of each month. A late charge of $25.00 Per Day will be charged for payment received after this time. Any family who has not paid by Tuesday for private pay parents and the 3rd day of the month for DHS Subsidy families will be dropped from enrollment unless prior approval has been granted by the director.

4) A late pick-up fee of $2.00 per minute per child for child not picked up by the 10 hour child care maximum. The appropriate charge will be added to the parents/guardians account and due immediately. Our center closes at 6pm if you pick your child up after 6pm you will be charged $2.00 per minute per child.

5) Quality Care CDC charges a $30.00 fee for all returned checks.

6) Quality Care CDC requires two week notice prior to withdrawing a child from the center. If a child is withdrawn without notice, the final two weeks payment will still be due. If payment is not made the parents/guardians will be turned over to a collection agency for payment.

7) At 30 months if your child is not toilet trained there will be an additional $30.00 per month fee. Due on the 1st day of the month. Children are never punished or forced when toilet training. AT 36 months if your child is not toilet trained there will be an additional $30.00 per week toilet training fee. Due every Monday by 6pm.

8) If you withdraw your children from Quality Care CDC Inc. and have an unpaid balance Quality Care CDC Inc. will seek legal action for the remaining balance on the account.

Enrolled Child(ren)(Required)

Name

Class

Initial Tuition

Discount

Weekly Tuition

A one time enrollment fee of $30.00 will be charged for the first child and a $15.00 fee for each additional child.

Parent/Guardian Name(Required)

First Last

Parent/Guardian Signature(Required)

Date

Attention Parents

We have a number of school age and pre school (4 & 5 year olds) children that are destroying the property of the daycare and destroying the facility itself by peeling at the paint, picking at the carpet, and other various things. Fighting is also unacceptable and your child will be suspended for fighting. We are asking that all parents discuss with their child(ren) about destroying property. Going forward, if your child is caught destroying the property or the facility of Quality Care CDC Inc, they will be suspended from the center for 2 full business days and the parents of the child will be financially responsible for the damage that their child caused. During the suspension, you will be responsible for finding alternate child care for your child(ren).

Parent/Guardian Signature(Required)

Date

Feeding Schedule

All foods are served to your child unless we receive a physician’s note stating that your child is allergic or unable to eat a particular item. Vegetables, Fruits, cereal and juice are provided by Quality Care Child Development Center Inc. Parents have to provide formula only.

Child(ren) Information(Required)

Child First Name

Child Last Name

Child Current Age

Feeding Time Schedule

Feeding Amount

Infant Feeding Policy

I acknowledge infants are not served table food until they are a minimum of 11 ½ months old

Special Feeding Instructions

Parent/Guardian Signature(Required)

Date

Enrollment Application

Enrolling Parent/Guardian Information

Child Information

Authorizations

Financial Agreement

Parent Handbook

Please read and check the parent handbook highlighted items below stating you have read and understood the guideless of the center.

Attention Parents

Feeding Schedule