Creative Solution Childcare Services dba Camp Central 4645 N. State Rd. 7, Lauderdale Lakes, FL 33319 | Direct Phone Line: (954) 857-4892 | Fax: (954) 735-6232 Monday thru Friday: Before School 6:30 am to 7:30 am | Afterschool 3:00 pm to 6:30 pm.

ENROLLMENT APPLICATION Child’s Name:

Date of Start:

Child’s Birth Date:

Home Phone:

Address: City:

State:

FL

ZIP Code:

*You are required to notify us within 24 hours of address/phone number change. Parent/Guardian Initials _________ Home

Name

Address

Cell Phone

Mother Father Guardian Work

Employer Name

Phone + Extension

Email

Mother Father Guardian Child’s Physician:

Phone:

Address:

City:

State:

ZIP:

May the center call another physician if unable to contact the one above? ☐ Yes ☐ No List all allergic reactions: ☐ Food ☐ Insects ☐ Medications ☐ Not yet known ☐ Other________________________ Parents allowed to pick up child: Mother ☐ Yes ☐ No Father ☐Yes ☐ No (If No, we need a copy of court order) Other people authorized to pick up and/or notify in case of illness, accident or emergency: Name

Relationship to Child

Signature of Person Enrolling Child

Cell Phone

PASSWORD (Please remember this word. Do not share it with anyone. This is only used to identify you to the center staff).

STATE OF FLORIDA, COUNTY OF _____________________________ The foregoing instrument was acknowledged before me this ___________ day of __________________________, 20 ________ by _______________________________________________. ________________________________________ Signature of Notary Public

Place Stamp Here ☐ Personally Known or ☐ Produced Identification -Type of Identification Produced ______________________________________

PERMISSION TO RECEIVE EMERGENCY CARE TO WHOM IT MAY CONCERN: I, ______________________________________ hereby give my consent to any emergency facility and / or physician to administer necessary treatment to my child, ________________________________________ in the event of an emergency for which I cannot be reached. I give consent to Creative Solution Child Care Services to see my child’s medical records and make decisions in emergency care as deemed necessary; as well as to transport by ambulance if the situation warrants it. Child’s Physician:

Phone Number:

(

)

Child’s Dentist:

Phone Number:

(

)

(

)

Known Allergies: Present Medications:

Date of last DPT or Tetanus:

Insurance Company:

Phone Number:

Policy Number: I, ____________________________________ agree to pay all costs and fees contingent on any emergency medical care and/or treatment of my child as secured or authorized under this consent.

Parent/Guardian Printed Name

Parent/Guardian Signature and Date

__________________________________________________________________________________________________

NO SMOKING POLICY DEPARTMENT OF CHILDREN AND FAMILIES - CHAPTER 386,F.S. – THERE IS NO SMOKING ON SCHOOL PREMISES.

NO VACATION POLICY OUR CENTER DOES NOT PROVIDE VACATIONS. Since school expenses continue whether or not your child is in attendance, no refunds or discounts are given for absences, vacation, sickness or holidays. Parent / Guardian Signature:

Today’s Date:

SIGN IN AND SIGN OUT POLICY This school will not assume responsibility for any child that has not been signed in upon arrival to school. Please make sure you sign your child in and out daily. Parent / Guardian Signature:

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OUR FEES AND RATES (Rates are subject to change each school year, and other fees may apply.) § § § § § § § § § § §

Preschool/VPK Registration Preschool (ages 2-5 years) Before VPK (for only VPK children) VPK Wrap Around Preschool/Wrap Around Late Payment Fee Before/After Care Registration Before Care ONLY After Care ONLY Before AND After Care Before/Aftercare Late Payment Fee LATE PICK-UP FEE (ALL SERVICES)

$100 annually (non-refundable) $130 weekly Before VPK (for only VPK children) $85 weekly $15 $25 annually (non-refundable) $25 weekly $65 weekly $85 weekly $15 $5 PER MINUTE AFTER CLOSING TIME

PAYMENT AGREEMENT POLICY Full weekly tuition is due each Monday in the form of cash or debit/credit card ONLY. Personal and/or business checks are not accepted. If payment is not received on the first day of weekly service (Monday), we may not accept your child until the weekly tuition is paid. A late payment fee will be charged if tuition is paid after Monday (see below table for rates). Since school expenses continue whether or not your child is in attendance, no refunds or discounts are given for absences, vacation, sickness or holidays. If your child is going to be absent for more than two days in a row, please let us know in advance. Should you withdraw your child from our center we require two weeks written notice. When a child is withdrawn, we immediately fill the spot with a child on our wait list. Should you wish to re-enroll your child, he/she will be placed on the waiting list. School Readiness and other Subsidized Programs Families must refer to their policies and procedures given at the time of registration. I understand my obligation to this Center and agree to pay childcare fees (refer to table above) of $___________on a weekly basis for service. Parent / Guardian Signature:

Today’s Date:

DISCHARGE POLICY The center reserves the right to terminate the enrollment of a child for any of the following but not limited to: ● Non-payment. ● Incomplete/Expired Health Records. ● Not observing the rules of the center as outlined in the ● Physical and/or verbal abuse of staff or children by parent agreement. parent or child. Parent / Guardian Signature:

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OTHER PERMISSIONS My child may participate in all activities of the school and use playground equipment. ☐ Yes

☐ No

Parent’s Signature:_____________________________________

The school might serve foods items that are not listed on a weekly menu during certain times such as birthday parties, holidays, or other special occasions. Food allergy lists are posted in every classroom and are always adhered to for both the weekly food menu as well as for other food items (cake, rolls, biscuits, apple pie, sweet potato pie, pumpkin pie, stuffing, gravy, water, juice, pretzels, raisins, fruits, gummy bears, cheese puffs, sprinkles, potato chips, corn chips, and other snacks. By signing below, you are giving authorization for your child to eat the snack foods listed above during these special occasions. ☐ Yes ☐ No Parent’s Signature:_____________________________________ I, the undersigned, do grant permission to Creative Solution Childcare Services to use the image of my child taken in photographs, video and audio recordings as well as of recorded oral descriptions of my child and his/her projects. Such use includes the editing, display, distribution, publication or otherwise use of said photographs, images and/or video taken of my child for use in materials that include, and may not be limited to, school website, printed materials such as brochures, newsletters, videos and digital images. ☐ Yes ☐ No Parent’s Signature:_____________________________________

LIABILITY WAIVER I do hereby, for myself, my heirs, executors and administrators, waive and release any rights and claims for damages I may have against this facility, it’s agents, representatives, successors, and assigns for any, and all, injuries and damages suffered by enrollee in connection with the program at Creative Solution Childcare Services. Parent / Guardian Signature:

Today’s Date:

ILLNESS POLICY PARENTS WILL BE CONTACTED AND ASKED TO PICK UP THEIR CHILD IMMEDIATELY FOR THE FOLLOWING: ● Fever (100 or above) ● Chronic Coughing / Wheezing ● Diarrhea ● Mucus / Watery Eye Drainage ● Rash ● Yellow / Green Nasal Discharge ● Vomiting ● Head Lice or Nits According to HRS and State Statues: If your child is sent home with one or more of the above symptoms a physician’s note will be required for re-admittance or 24 hours symptom free. We realize this is an inconvenience, but we must protect your child and other children. Parent / Guardian Signature:

Today’s Date:

HOURS OF OPERATION • • •

Before / After Care: Monday to Friday from 6:30 am - 6:30 pm on regular school days. Teacher Planning Days: Monday thru Friday from 7:00 am - 6:00 pm Summer Camp: Monday to Friday from 6:30 am - 6:30 pm

A $5.00 per minute late pick-up fee will be charged for every minute after closing time. Parent / Guardian Signature:

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HOLIDAYS

Our center will be closed on the following national holidays: • New Year’s Day • • Martin Luther King Jr. Day • • President’s Day (Teacher Training Day) • • Good Friday (Teacher Training Day) • • Memorial Day • • Independence Day •

Labor Day Veterans Day Thanksgiving Day Day After Thanksgiving Christmas Eve Christmas Day

● ●

We MAY be closed on other days due to other major holidays, weather, or other circumstances. Parents will be notified in advance about these closures.

Parent / Guardian Signature:

Today’s Date:

ALTERNATIVE NUTRITION PLAN HUMAN SERVICES DEPARTMENT / Bureau of Children’s Services Child Care Licensing and Enforcement Section - Control Form 6091-5 (Rev. 7/93) Dear Parents: In accordance with the Broward County Child Care Ordinance / Family Child Care Ordinance, parents, and the child care facility are urged to work cooperatively to assure that children are provided with nutritious snacks and meals where are not provided by the facility. Please read the following carefully, and sign.The facility agrees to provide a nutritious: (Operator / Director checks those which apply) ______ Breakfast ______ Lunch ___X___ Mid-afternoon snack

Meals provided by all parents shall consist of the following: A. Meal / Poultry / Fish 2 ounces Or cheese 2 ounces Or eggs 1 egg Or peanut butter 4 tablespoons Or dried beans and peas ½ cup B. Fruits (2 or more) ½ cup Or Vegetables ½ cup Or Fruits and Vegetables C. Bread 1 slice D. Butter 1 teaspoon E. Milk 1 cup

Children will not be allowed to bring their own food unless a medical note is provided. Upon enrollment, please notify the director and the teacher of any food allergies or restrictions your child has. The parent agrees to provide (AT HOME) a nutritious: (Parent checks these which apply.) ___X___ At home Dinner I have read the preceding and agree to meet the child’s nutritional needs as defined in this page. I have also revised and read the information about meals provided by all parents: Parent / Guardian Signature:

Today’s Date:

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GUIDANCE POLICY WHAT WE DO FOR YOUR CHILD. We maintain discipline at our school by building each child’s self esteem while teaching the skills for internal self-control. Our teachers are advocates of children dedicated to helping them grow in a positive way. HOW DO WE DO THIS? 1. HAVE CLEAR EXPECTATIONS. When children know what to expect in the classroom setting (rules), they are able to follow the rules without a great deal of teacher intervention. Example: Teacher will say: “We use smocks to paint” or “We touch our friends nicely”. 2. MAKE NON-DIRECTIVE STATEMENTS. By labeling the situation, we give direction and we give the child time to change. Example: Teacher will say: “Susie, when you hold your paintbrush like that, paint gets on the floor.” Or “John, you look like you are getting upset, what’s wrong?” 3. STATE THE DESIRED BEHAVIOR. When teachers need to give direction, they will state what they want to happen in clear and simple directions. Example: “We need to put our toys on the shelf now”. Children are able to be successful when expectations are clearly stated. 4. FIND ALTERNATIVES. Sometimes we need to redirect a child. We can teach these skills by offering other alternatives to them. Example: “There are four people with that toy already. Joey, what else can you find to play with right now?” 5. PROVIDE QUIET TIME. Sometimes children need to have a moment away from the group to settle themselves down and regain self-control. We provide comfortable places within the classroom where children may go, in order to provide “timeout.” 6. ACKNOWLEDGE APPROPRIATE BEHAVIOR. When we notice a child who is behaving in desired way praise the child. Example: “Tom, I noticed you are working hard at the puzzle”, or “I noticed how well you are sharing the blocks today, Karen.” Children love to be caught doing something good. Parent / Guardian Signature:

Today’s Date:

CHRONIC DISRUPTIVE BEHAVIOR We will make every effort to work with the parents of children having difficulties in our center. We are here to serve and protect all of our children, although children displaying chronic disruptive behavior that might has been determined to be upsetting to the physical or emotional wellbeing of another child may require the following actions. INITIAL CONSULTATION. The Director may require the parent(s) of any child who attends the center to meet for a conference. The problem will be defined on paper. Goals will be established and the parent will be involved in creating approaches towards solving the problem. SECOND CONSULTATION. If the initial plan for helping the child fails, the parent(s) will again be required to meet with the Director. Another attempt will be made to identify the problem, outline new approaches to the problem, and discuss the consequences if progress is not apparent. SUSPENSION. When the previous attempts have been followed and no progress has been made towards solving the problem, the child may be suspended from the center indefinitely. The Director may immediately suspend a child at any time he/she exhibits a behavior that is harmful to him/herself or to others. A parent may be called from work at any time the child exhibits uncontrollable behavior that cannot be modified by the center staff. That parent may be asked to take the child home immediately. Suspension from the center program may vary from a few hours to an indefinite period.

☐ Yes

☐ No

Parent’s Signature:_____________________________________

DISCHARGE POLICY REMINDER The center reserves the right to terminate the enrollment of a child for any of the following but not limited to:

● Non-payment. ● Incomplete/Expired Health Records. ● Not observing the rules of the center as outlined ● Physical and/or verbal abuse of staff or children in the parent agreement. by parent or child. Page | 6

ACKNOWLEDGEMENT

I have read all information and signed all pages where indicated in this packet and agree to comply with all the policies of this center. I further understand that there will be no refund on registration or tuition fees. Parent / Guardian Signature:

Today’s Date:

I have received and read the following brochures attached to this packet “Know Your Child Care Center” and “Influenza Virus” and the Parent Handbook. Parent / Guardian Signature:

Today’s Date:

Physical Activity Participation Children attending our center shall play outdoors daily when weather and air quality conditions do not pose a significant health risk. Time planned for outdoor play and physical activity depends on the age group and weather conditions. Activities shall include structured play (led by the teacher) and free play (not led by an adult). • Toddlers (12 months to 3 years) shall participate in 60 to 90 minutes per day of moderate to vigorous physical activity. • Preschoolers (3 to 5 years old) shall participate in 90 to 120 minutes per day of moderate to vigorous physical activity. • Children shall be dressed appropriately for the weather, including wearing appropriate seasonal clothing and footwear, so they can participate fully, move freely, and play safely. • Preschool providers will inform parents, caregivers, and families that children need to be dressed appropriately for the current weather conditions to play outdoors. Children should wear clothing appropriate for the current weather: o Cold weather / Snow. Heavy coat, waterproof boots, hat, and mittens. o Rain. Raincoat and waterproof boots. o Different temperatures during the day. Layers of clothing. o Footwear should provide support for running and climbing. Examples of appropriate footwear include sneakers, gym shoes, and other shoes with rubber soles that enclose the feet and will not come off easily. • Examples of inappropriate clothing and footwear include: § Footwear that can come off while running or that does not provide support for climbing (examples: flip-flops, clogs, etc.) § Clothing that can catch on playground equipment (examples: clothes with drawstrings or loops). § Clothing that does not protect children from the current weather conditions.

By signing below, I accept the described policy on Physical Activity Participation at the school. Parent / Guardian Signature:

Today’s Date:

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