2017-2018 Enrollment Packet
Welcome to Waterstone Preschool! We are honored that you’ve chosen to enroll your little one in our program and we are looking forward to partnering with your family for a year of learning and fun. The following information is contained in this enrollment packet: • Health Status Form (This form must be signed by your child’s doctor. If your child has
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recently had a physical, you don’t need to schedule an appointment or bring your child in to the doctor. Drop-off the form with your child’s doctor to be filled out and signed. Bring it with you to Enrollment Packet drop-off days or have your doctor fax it to 303.593.4561, attention Lisa.) Immunization Certificate (This form must be printed on a state approved immunization form or the one provided in this packet.) Emergency Card (Requires addresses, phone numbers, and drivers' license numbers for all Emergency Contacts).
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Meet My Child Form Permission to Photograph Form Over the Counter Medication Form Parent Handbook Signature Form Automatic tuition withdrawal form (ACH) (Please note: there will be a $10 fee for any late
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Enrollment packet check list
tuition received and a $30 Non-Sufficient Funds (NSF) fee for any returned checks.)
Paperwork: Licensing requires that we have the enrollment packet, Health Status Form (requiring a physician’s signature), and Immunization Certificate completed after May 31st and before the first day of school. Please make sure all paperwork is dated after May 31st. ALL
drop--off day. completed paperwork should be turned in at the scheduled Enrollment Packet drop All forms MUST be completed and turned in before we can allow your child to come to school. Please help us stay in compliance with our childcare license and the rules we are required to follow. Parent Handbook: The Handbook can be downloaded at: www.waterstonechurch.org/preschool-parent-connection/ Please read through the Parent Handbook for further information about our program. This handbook will equip you and your child with the information needed to have a great year. Tuition is calculated based on the number of weeks your child attends. That amount is then pro-rated over 9 equal payments. Tuition is due on the 5th of the month and is considered late by the 10th of the month. Tuition payments made after the 10th are assessed a $10 late fee. If you opt to pay your tuition with cash or check each month we require September and May tuition in September. If you opt to use the Automatic Tuition Withdrawal (ACH) option you are only required to pay September tuition in September. We look forward to a wonderful year of growth and exploration with your child! If you have any questions, please don’t hesitate to contact me. Anne Yost Waterstone Preschool Director 303.972.2200 x119 /
[email protected] fax: 303.593.4561
HEALTH STATUS FORM
for enrollment in a child care facility The child care facility must obtain, for every child who enrolls in the child care program, a signed and dated statement of the child’s current health status which indicates the child’s abilities and/or limitations to participate in a regularly scheduled child care program. This report is to be filled out by a licensed physician or other health care professional who has seen the child within the last twelve months for children over 2 1/2 years of age and within the last 6 months for children under 2 1/2 years of age. Name of Facility:
Waterstone Preschool
Child’s Name
DOB
Describe any health condition or developmental concern including, but not limited to, allergies, seizures, asthma, diabetes, heart of respiratory conditions, and physical disabilities requiring the facility’s special attention:
Medication(s) prescribed:
Allergies: and prescribed routine: Date of my most recent examination of the child: Date of next required visit:
Name of physician/health care professional Address
City
State
Zip
Phone
Signature of licensed physician or other health care professional
Date
CHILD EMERGENCY CARD Child’s Name: Address:
Birthdate:
Mother’s Name:
Father’s Name:
Home Phone:
Home Phone:
Work Phone:
Work Phone:
Cell Phone:
Cell Phone:
Person other than parent to be contacted in case of emergency: Name:
Phone:
Address: Name(s) of person(s) other than parent to whom the child may be released: 1.
Driver’s License #
Address: 2.
Phone: Driver’s License #
Address: Physician:
Phone: Phone:
Address: Hospital:
Phone:
Address: Dentist:
Phone:
Address: Medication taken daily:
Allergies:
I do hereby authorize officials of Waterstone Preschool to contact directly the persons named on this card, and do authorize the named physician, dentist, or hospital to render treatment as necessary in an emergency. In the event that parents, guardians, emergency contacts, or the medical personnel named on this card cannot be reached, the program staff are hereby authorized to take whatever action is deemed necessary in their judgment for the health of the child.
Signature:
Date:
Meet My Child Name:
Date of Birth:
Class enrolled in: (find your child’s class on the Class List emailed out with the Enrollment Packet or on the website.
What does your child like to be called? Is this your child’s first experience in a school setting?
Yes
No
What are 5 words that describe your child? What can he/she do by himself/herself? What is difficult or frustrating for him/her? How do you solve a problem with your child? Eating habits and/or feeding schedule: Soothing routines: Pacifier? Yes
No
Does your child take naps? Yes
No
Is your child potty trained? Yes
No Are there any specials instructions?
Please describe your child’s personality, including likes, dislikes, fears, etc.
What are some of the goals and/or expectations you have for your child this school year?
Is your child receiving any additional outside services, such as Physical Therapy, Occupational Therapy, Speech Therapy, etc? Yes No If yes, please briefly explain. Other care apart from Waterstone Preschool: Your Family Who does your child live with? Does your child have any siblings? If yes, names and ages:
Do you have any pets in your home? If yes, please include and names:
Other languages spoken: Activities you enjoy doing together:
Special traditions (holidays, vacations, events, etc.):
Ways you would like to be involved in the classroom at Waterstone Preschool:
PERMISSION TO PHOTOGRAPH give permission for Waterstone Preschool
I, (parent’s or guardian’s name)
to photograph my child,
for the following purposes:
Type of Use:
(Please check one) Decline Permission Grant Permission
Still photos or videos to be shown during the annual Christmas and/or Graduation video Craft projects Annual school portraits I understand that it is my responsibility to update this form in the event that I no longer wish to authorize one or more of the above uses. I agree that this form will remain in effect during the term of my child’s enrollment. Signed:
Date: (parent or guardian)
OVER THE COUNTER MEDICATION RELEASE / SUNSCREEN As per Colorado State Licensure Regulations, please specify what items below you would like your child to receive. Please be advised that if your child needs these items as treatment, rather than preventive, we will require a doctor’s order to treat. All products are provided by the parent, as needed and must be labeled with your child’s name. Parents are required to apply long-lasting sunscreen to their children prior to their arrival at school or provide another form of sun protection such as a hat.
Diaper Ointment Sun Screen Lotion Lip Balm
Child’s Name:
DOB:
Parent’s Signature:
Date:
PARENT HANDBOOK SIGNATURE SHEET I have read the policies and procedures regulating Waterstone Preschool as stated in the Parent Handbook and agree to abide by these rules and regulations. Parents can download an electronic copy from the website or view a hardcopy kept in the Preschool Director’s office. Parent or Guardian’s Signature
Date
AUTHORIZATION AGREEMENT FOR TUITION PAYMENT VIA AUTOMATIC CLEARING HOUSE (ACH) ELECTRONIC FUNDS TRANSFER I/We wish to contribute by way of Automatic Clearing House (ACH) electronic funds transfer. Therefore, I/we hereby authorize Waterstone Community Church to debit my/our account in the amount indicated below at the financial institution listed below.
Financial Institution
Account Number
Address
Bank Routing Number
City, State, Zip Code
* Attach a voided check from the account you would like the funds drawn from. * Waterstone Preschool Tuition - Valid for the 20172017- 2018 School Year Transfer will be made on the 5th of each month Amount of each monthly transfer (September-May): $_____________ It is understood and agreed that I/we may terminate or modify this agreement at any time upon five business days prior notice to Waterstone Community Church. If joint account, both account owners must sign below:
Name (please print)
Name (please print)
Signature
Signature
Date
Date
Please contact Doug Angell at 303.972.2200 if you have any questions. Waterstone Community Church 5890 South Alkire Street Littleton, Colorado 80127 Phone: 303.972.2200 Fax: 303.593.4561 www.waterstonechurch.org
Enrollment Packet Check List for the 2017/2018 School Year Child’s Name: Child’s Class:
Name of Form:
Parent Use
Office Use
Registration Form
Date Received:
Health Status Form
Date Received:
Immunization Certificate
Date Received:
Emergency Card
Date Received:
Meet My Child Form
Date Received:
Misc Signature and Release Form
Date Received:
at time of registration)
Date Received:
Completed ACH form
Date Received:
$25 Activity Fee (if not paid online
