Child Enrollment Form

1st Child's Information

Parent's Information

Emergency Contact 1
In the event of an emergency, please contact:

Emergency Contact 2
In the event of an emergency, please contact:

Other people authorized to pick up your child

I hereby give HOME Preschool staff and personnel permission to access my child's file.

All information sighted or heard, shall be treated as strictly confidential and shall not be disclosed to or discussed with anyone other than those authorized to receive such information, unless disclosure is authorized by law.

Once you have enrolled your child with HOME Preschool, you will want to make sure that it will be a positive and rewarding experience for everyone involved. An effective childcare partnership will benefit you, us, and the child. We are counting on you to keep up your end of the bargain; they keep your child smiling, safe, healthy, and happy while you're at work, and you agree not to take advantage of them. Through good communication and by working together, we can help to ensure that your child receives the best start to his or her life.

There are several steps you can take, as a parent, to build a successful partnership with us. You can show appreciation by being thoughtful and considerate in the following ways:

• Be sure you read and understand our policies/procedures and requirements as outlined in our Parent Handbook before you enroll your child. These rules are put in place to help all involved succeed. Do your best to abide by the policies and procedures to which you have agreed.
• Turn in all necessary paperwork. Even before your child attends the first day of child care, you'll need to submit a number of documents, such as immunization records and medical health release forms. State law mandates that all child care programs comply with this law, so help us and hand in forms on time.
• Bring up any problems or concerns immediately. We want to make sure you’re comfortable and prove to you that you have made the right choice in choosing HOME Preschool to care for your child(ren). Therefore, if any problems or concerns should arise, please feel free to discuss with your child’s teacher or the Director.
• Drop-off your child(ren) on time. We have set a schedule for our childcare center and late arrivals can prove to be disruptive to the other children in our care. Parents are expected to drop-off their child(ren) no later than 9:30 a.m., between the hours of 11:00 a.m. and 11:30 a.m. or after 2:00 p.m. and must sign in and out every day.
• Pick-up your child(ren) on time. We close at 7:00 p.m. daily and we encourage parents to pick up their child(ren) before then. We charge $5/min after 7:00 p.m. up to an hour as long as there is communication with the parent as to their whereabouts. After an hour grace period, we will be forced to contact the Police Department and/or Department of Children and Families (DCF).
• Give advance notice of absences or vacations. If it is predetermined that a child will be absent, we require a day notice or whenever possible even more notice is better. This helps us maintain staffing, and unlike other childcare centers we offer drop-in services and can only care for a limited number of children. So, if we have advance notice of absentees, then it is possible for us make arrangements with other family’s inquiring about drop-in care for their child.
• Keep us up-to-date. Notify the Director of any changes in your child(ren) file including but not limited to phone numbers, contacts and addresses.
• Pay your tuition on time. Payment is due on Monday of each week or on the first day of care. If payment is received after Tuesday of each week, a $20 late fee will be charged.
• For ELC parents only. If the ELC reimbursement rate does not cover the full tuition rate, you will be
  responsible to pay the difference.
  • You are only allowed 3 absences per month, any additional absence without a doctor’s note will incur an additional daily fee.

My signature below indicates that I have received a copy of the Parent’s Responsibilities, and I have read, understand and agree to this policy.

We believe that the discipline of a child is achieved through patience, consistency, and positive reinforcement. We also try and teach the children in our care manners, kindness and to be respectful to others. One of the ways in which we do this is by the example we as providers set. We understand that our actions and reactions speak much louder than our words. The rules of the center are explained to the children frequently, so they know what’s expected of them. Once a child is old enough to understand the rules and disobeys them by exhibiting inappropriate behavior (hitting, aggression, etc.), hurts others, or property, the following developmentally appropriate guidance techniques will be used:

1. Positive Reinforcement: The child will be encouraged when he or she is demonstrating acceptable behavior.
2. Redirection: The child is redirected to another activity and given an opportunity to try again at another time.
3. Time-Out: The child is separated from the group for an age appropriate amount of time (one minute per one year of age). This technique is only used when a child repeatedly will not follow our directions or listen to our words, is exhibiting temper tantrum type behavior, or hurting one’s self, others or equipment. When the child shows that he or she is ready to demonstrate acceptable behavior, they are encouraged to join the rest of the group to try again.
4. Last Resort: When a child’s behavior is continually upsetting or dangerous to others, a conference will be called with the parents. If the problem cannot be resolved, arrangements will have to be made for the child to go elsewhere for care.
5. Children shall NOT be subjected to discipline that is severe, humiliating, or frightening.
6. No cruel, harsh, physical, or unusual punishments shall be permitted.
7. No child shall be delegated or permitted to discipline another child.
8. No physical restraints, equipment, devices, or furniture shall be used to confine a child, including, without limitation, swings, walkers, and spinners.
9. No child shall be confined in an enclosed area, such as a closet, locked room, box, or bathroom.
10. No child shall be subjected to profane language, threats, derogatory remarks, or other verbal abuse.
11. No child shall be punished for failure to eat or sleep, or for toileting accidents.
12. No child shall be punished by with-holding food, rest, or use of the toilet.
13. No physical punishment shall be used, such as, but not limited to, spanking, hitting, striking, biting, or pinching.
14. No child shall be threatened with any punishment that is prohibited by this paragraph.

Note: Sometimes if both a parent and a provider are both in the same area (examples would be during drop-off and pick-up times) a child may forget the rules and test the boundaries. Please help show your child that you respect us, the rules of our center, and our property by reminding them that the rules still apply when you are around. We will also remind them of the rules and correct them if needed.

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.

H.O.M.E Preschool recognizes that exclusion from the early childhood educational program of the school, whether by suspension or expulsion, is the most severe sanction that can be imposed on a student and one that cannot be imposed without due process. This policy shall define and publish the types of offenses that would lead to exclusion from school.

Trial Period
The first thirty (30) days will be regarded as a trial period, in which case either party may terminate the contract without notice. After the first thirty (30) days of enrollment, a minimum of fourteen (14) days written notice from parent is required to terminate the contract; however, Administration is reserved the right to disenroll a student for any purpose or
reason at any time. If fourteen (14) days written notice is not given, parents may be asked to pay for the remaining time.

Grounds for suspension or expulsion
If the following types of conduct occur by student or parent at school, on school grounds, or in vehicles owned by the school then they are grounds for suspension or expulsion.

• Use of violence, force, coercion, threat, intimidation, or similar conduct in a manner that constitutes a substantial interference with school purposes;
• Willfully causing or attempting to cause substantial damage to property, stealing or attempting to steal school’s or another person’s property, or repeated damage or theft involving property;
• Causing or attempting to cause personal injury to a school employee, to a school volunteer, or to any student. Personal injury caused by accident, self-defense, or other action undertaken on the reasonable belief that it was necessary to protect oneself or some other person shall not constitute a violation of this subdivision;
• Uncontrollable behavioral issues including but not limited to tantrums, hitting, biting, throwing items, non-compliance etc.
• H.O.M.E Preschool’s Uniform Policy is to provide students with an environment where they feel confident and successful. Continuous disregard of our uniform policy may constitute the need for suspension or expulsion.
• In cases of non-payment, parents will be given a two (2) weeks grace period from initial non-payment. If payment is not received and account brought up to date, the account will be terminated, and parents will have to source alternate care for their child(ren).

My signature below indicates that I have read and agree to abide by this policy.

The center shall assure that each age group or class must have a written and followed plan of scheduled daily activities. The plan shall be posted in a conspicuous location accessible to parents. The written plan must meet the needs of the children being served, and must include alternative activities in case of inclement weather, and include scheduled activities that:

1. Promote emotional, social, intellectual and physical growth.
2. Shall include a minimum of forty (40) minutes of combined indoor and outdoor physical activity for every three (3) hours in care for children one (1) year of age up to four (4) years of age.
3. Shall include a minimum of forty (40) minutes of outdoor physical activity for every three (3) hours in care for children enrolled in after school child care programs.
4. These activities may include but are not limited to playground equipment, ball games, teacher lead small group games, and teacher directed large group games. In the event of inclement weather, a rainy-day activity schedule shall be followed.
5. Children’s clothing and shoes must be appropriate for the activity schedule; i.e. sneakers or closed toe shoes, jackets, pants or short pants etc. No flip flops or sandals are allowed.

My signature below indicates that I have received a copy of the Physical Activity Policy, and have read and understand this policy.

In the event of a medical emergency situation, as deemed by the Director or designated person in charge, 911 will be notified immediately then Parents/Guardians will be notified. If there is an immediate need for medical attention, the undersigned grants consent for any x-rays, treatment or hospital care to be rendered to said minor upon the advice of a physician.

Child's Information

Parent's Information

HOME Preschool has my permission to obtain emergency medical treatment for my child named above, when I cannot be reached or if a delay in reaching my child would be dangerous for him/her. I understand that it is my responsibility to update this form if any information provided above has changed.

My signature below indicates that the information I have provided within this form is true, and I have read and understand this agreement.

Pursuant to 65C-22.005(1)(c)2., F.A.C, licensed child care facilities must obtain written permission from parents/guardians regarding a child’s participation in food related activities. These activities include such things as: group cooking projects, gardening, program wide celebrations, and birthdays.

I give permission for my child to participate in food related activities and special occasions wherein food is consumed.

Please provide the following information (check the one that applies):

I understand that it is my responsibility to update this form in the event that my decision for permission or any other information provided within changes. I agree that this form will remain in effect during the term of my child’s enrollment.

My signature below indicates that I have received a copy of this form, and I have read and understand this policy.

HOME Preschool may photograph children while at daycare, on fields trips, or during activities and may use the image(s) to promote child care services only, either in print or on the internet.

I understand that my child(ren) may be photographed during normal daycare hours, field trips, or during activities. I understand that these photographs may be used in promoting child care services, either in print or on the internet.

I understand that it is my responsibility to update this form in the event that I wish to change my decision. I agree that this form will remain in effect during the term of my child’s enrollment. I understand that there will be no payment for me or my child’s participation in this release.