Kendall Enrollment Application

Child Care Application For Enrollment

Student Information:
Date of Birth:(Required)
Date of Enrollment:(Required)
Full Name:(Required)
Child's Physical Address:(Required)
Days of the Week in Care:(Required)
Family Information:
Address:(Required)
Address:(Required)
Employer Address:(Required)
Employer Address:(Required)
Custody:(Required)
Emergency Contact:
Medical Information:
Address(Required)
Address(Required)
Address(Required)
Please list allergies, special medical or dietary needs, or other areas of concern:(Required)
Emergency Contacts:
Child will be released only to the custodial parent(s) or legal guardian(s) and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason, the custodial parent(s) or legal guardian(s) cannot be reached:
Address(Required)
Address
Address
Address
  • Sections 7.1 and 7.2, of the Child Care Facility Handbook, require a current physical examination (Form 3040) and immunization record (Form 680 and 681) within 30 days of enrollment.
  • Section 7.3, of the Child Care Facility Handbook, requires that parents receive a copy of the Child Care Facility Brochure, "Know Your Child Care Facility" (CF/PI 175-24), or
  • Section 8.3, of the Family Day Care Home/Large Family Child Care Home Handbook, requires that parent(s) receive a copy of the family day care home brochure, "Selecting A Family Day Care Home Provider" (CF/PI 175-28).
  • Section 7.3, C.3 of the Child Care Facility Handbook, requires that parents are provided food and nutrition policies used by the child care facility.
  • Section 2.8, of the Child Care Facility Handbook, requires that parents are notified in writing of the disciplinary and expulsion policies used by the child care facility, or
  • Section 2.3, of the Family Day Care Home/Large Family Child Care Home Handbook, requires that parents are notified in writing of the disciplinary and expulsion policies used by the family day care provider.

Your signature below indicates that you have received the above items and that the information on this enrollment form is complete and accurate. I hereby grant permission for the staff of this facility to have access to my child's records.

Date:(Required)

Distracted Adult brochure

A change in daily routine, lack of sleep, stress, fatigue, cell phone use, and simple distractions are some things parents experience and can be contributing factors as to why children have been left unknowingly in vehicles...

Facts About Heatstroke:


It only takes a car 10 minutes to heat up 20 degrees and become deadly.

Even with a window cracked, the temperature inside the vehicle can cause heatstroke.

The body temperature of a child increases 3 to 5 times faster than an adult's body.

Prevention Tips:


  • Never leave your child alone in the car and call 911 of you see any child locked in a car!
  • Make a habit of checking the front and back seat of the car before you walk away.
  • Be especially mindful during hectic or busy times, schedule or route changes, and periods of emotional stress or chaos.
  • Create reminders by putting something in the back seat that you will need at work, school or home such as a briefcase, purse, cell phone or your left shoe.
  • Keep a stuffed animal in the baby's car seat and place it on the front seat as a reminder when the baby is in the back seat.
  • Set a calendar reminder on your electronic device to make sure you dropped your child off at child care.
  • Make it a routine to always notify your child's child care provider in advance if your child is going to be late or absent; ask them to contact you if your child hasn't arrived as scheduled.

During the 2018 Legislative Session, a new law was passed that requires child care facilities, family day care homes, and large family child care homes to provide parents, during the months of April and September each year, with information regarding the potential for distracted adults to fail to drop off a child at the facility/home and instead leave them in the adult's vehicle upon arrival at the adult's destination.

My signature below verifies receipt of the Distracted Adult brochure
Date:(Required)

Influenza Virus, The flu A Guide to Parents

What is the influenza (flu) virus?
Influenza ("the flu") is caused by a virus which infects the nose, throat, and lungs. According to the US Center for Disease Control and Prevention (CDC), the flu is more dangerous than the common cold for children. Unlike the common cold, the flu can cause severe illness and life threatening complications in many people. Children under 5 who have the flu commonly need medical care. Severe flu complications are most common in children younger than 2 years old. Flu season can begin as early as October and last as late as May.

How can I tell if my child has a cold, or the flu?
Most people with the flu feel tired and have a fever, headache, dry cough, sore throat, runny or stuffy nose, and sore muscles. Some people, especially children, may also have stomach problems and diarrhea. Because the flu and colds have similar symptoms, it can be difficult to tell the difference between them based on symptoms alone. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, and dry cough are more common and intense. People with colds are more likely to have a runny or stuff nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations.

What should I do if my child gets sick?
Consult your doctor and make sure your child gets plenty of rest and drinks a lot of fluids. Never give aspirin or medicine that has aspirin in it to children or teenagers who may have the flu.

CALL OR TAKE YOUR CHILD TO A DOCTOR RIGHT AWAY IF YOUR CHILD:

  • Has a high fever or fever that lasts a long time
  • Has trouble breathing or breathes fast
  • Has skin that looks blue
  • Is not drinking enough
  • Seems confused, will not wake up, does not want to be held, or has seizures (uncontrolled shaking)
  • Gets better but then worse again
  • Has other conditions (likek heart or lung disease, diabetes) that get worse

How can I protect my child from the flu?
A flu vaccine is the best way to protect against the flu. Because the flu virus changes year to year, annual vaccination against the flu is recommended. The CDC recommends that all children from the ages of 6 months up to their 19th birthday receive a flu vaccine every fall or winter (children receiving a vaccine for the first time require two doses). You also can protect your child by receiving a flu vaccine yourself.

What can I do to prevent the spread of germs?
The main way that the flu spreads is in respiratory droplets from coughing and sneezing. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and infect someone nearby. Though much less frequent, the flu may also spread through indirect contact with contaminated hands and articles soiled with nose and throat secretions. To prevent the spread of germs:

  • Wash hands often with soap and water.
  • Cover mouth/nose during coughs and sneezes. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
  • Limit contact with people who show signs of illness.
  • Keep hands away from the face. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose or mouth.

When should my child stay home from child care?
A person may be contagious and able to spread the virus from 1 day before showing symptoms to up to 5 days after getting sick. The time frame could be longer in children and in people who don't fight disease well (people with weakened immune systems). When sick, your child should stay at home to rest and to avoid giving the flu to other children and should not return to child care or other group settings until his or her temperature has been normal and has been sign and symptom free for a period of 24 hours.

For more information about the dangers of the flu and how to protect your child, visit: http://www.cdc.gov/flu/ or http://www.immunizeflorida.org/

During the 2009 legislative session, a new law was passed that requires child care facilities, family day care homes and large family child care homes provide parents with information detailing the causes, symptoms, and transmission of the influenza virus (the flu) every year during August and September.
My signature below verifies receipt of the brochure on Influenza Virus, The flu A Guide to Parents:

Date Received:(Required)

Rilya Wilson Act

Pursuant to s. 39.604, Florida Statutes, a child from birth to the age of school entry, who is under court-ordered protective supervision or in out-of-home care and is enrolled in an early education or child care program must attend the program 5 days a week unless the court grants an exemption. A child enrolled in an early education or child care program who meets the requirements of this act may not be withdrawn from the program without prior written approval of the Department or community-based care lead agency. If a child covered by this act is absent, the program shall report any unexcused absence or seven excused absences to the Department or the community-based care lead agency by the end of the business day following the unexcused absence or seventh consecutive excused absence.

Educational stability and transition are key components of this act to minimize disruptions, secure attachments and maintain stable relationships with supportive caregivers of children from birth to school age. Successful partnerships are imperative to ensure that these attachments are not disrupted due to placement in out-of-home care or subsequent changes in out-of-home placement. A child must be allowed to remain in the child care or early education setting that he/she attended before entry into out-of-home care, unless the program is not in the best interest of the child. If a child from birth to school-age leaves a child care or early education program, a transition plan needs to be developed that involves cooperation and sharing of information among all persons involved, respects the child's developmental stage and associated psychological needs, and allows for a gradual transition from one setting to another.

This law provides priority for child care services for specified children who are at risk of abuse, neglect, or abandonment. These children are also known as Protective Services children.

Rilva Wilson Act Requirements:

  • ✓ Protective services children MUST be enrolled to participate 5 days per week.
  • ✓ Protective services children MAY NOT be withdrawn without prior written approval from the Department of Children and Families (DCF) or Community Based Care (CBC).
  • ✓ If a Protective Services child has 7 consecutive excused or any unexcused absence, the child care provider MUST notify the appropriate community based care staff.
  • ✓ The Department and child care providers MUST follow local protocols set up by the CBC to ensure continuity.
  • ✓ if it is not in the best interest of the child to remain at the child care or early education program, the caregiver MUST work with the Case Manager, Guardian Ad Litem, child care and educational staff, and educational surrogate, if one has been appointed, to determine the best setting for the child.
Community-Based Care Lead Agencies Contact Information:
http://www.dcf.state.fl.us/programs/cbc/docs/leadagencycontacts.pdf
** If you have concerns regarding any child that you may care for, please contact the Florida Abuse Hotline at 1-800-96-ABUSE**

My signature below verifies receipt of the flyer on the Rilya Wilson Act from the Department of Children and Families.

Date Received:(Required)

Discipline Policy

Parents,
We are required by the Department of Children and Families to provide parents with a written discipline policy. Please sign this form.

Our program will insure that age appropriate, constructive disciplinary practices are used for your child. This care will allow the child time to look over his or her behavior. We will encourage children to choose alternatives to improve behavior. To insure a safe and successful program, discipline is a must. We welcome the ideas of parents; please feel free to share them with us.

The following steps will be used for behavior modification:
1st Children will be corrected and asked to change their behavior.
2nd Children will be re-directed from situation.
3rd Children will be placed in "Thinking Chair" according to age.
4th Parents will be contacted if behavior is not corrected.
5th Children shall not be subjected to discipline which is severe, humiliating, or frightening.
6th Discipline shall not be associated with food, rest or toileting or playground time.
7th Spanking or any other form of physical punishment is prohibited.
8th Children may not be denied active play as a consequence of misbehavior.

Date:(Required)

Expulsion Policy

Springview Academy is centered on the children for whom we care. We seek to provide programs designed to support children's growth and to challenge them to learn, each as an individual with a unique learning style and way of responding to the world. Given the diversity of the families and community that we serve, it is incumbent upon us to recognize and appreciate the characteristics and behaviors that each child and family brings to our program. Springview Academy seeks a solid partnership with our families as a basis for their children's success within our program. Because Springview Academy has a child-centered/family approach we seek to accommodate a wide range of individual differences, it is only on rare occasions that a child's/family's behavior may warrant the need to find a more suitable setting for either a short term or permanent basis. We will do everything possible to work with you to avoid a child's disenrollment from the center. The following are some reasons why we would have to expel a child or family from the center.

Some examples of such instances include:

Child's actions

  • Child unable to adjust to the program after a reasonable amount of time
  • Ongoing physical or verbal abuse to staff or other children
  • Ongoing uncontrollable tantrums/angry outbursts
  • A danger to him/herself and or to others


Parental actions
  • A parent/guardian fails to abide by Center policies or requirements imposed by the appropriate licensing agency.
  • Non-payment of tuition.
  • A parent/guardian demands special services that are not provided to other children and cannot reasonably be delivered by the program. This includes requests that depart from the philosophy of Springview Academy.
Immediate Causes for Expulsion
  • A parent/guardian is physically or verbally abusive or intimidating to Center staff, children, or anyone else at the Center.
  • Potentially dangerous behavior by a parent or child.

Working Towards a Positive Solution

The decision to expel a child from Springview Academy is a difficult one for both the Center and the family. In all cases, it is the goal of Springview Academy to act quickly, thoughtfully and thoroughly to communicate, address and resolve concerns relating to the children in our care. Center personnel will attempt to work with a family to take constructive steps to finding a solution that resolves the problem(s), before disenrollment occurs.

When a child's teacher or an administrator has concerns about a child's behavior or other circumstances, he or she will document such concerns as soon as they arise. The Center will inform and involve the child's parent/guardian by notes, phone calls, and meetings, as necessary, to establish a collaborative environment. If the child's behavior is problematic, a review of that behavior using the Center's developmental profile and other developmental tools will aid in understanding the behavior in it's appropriate context. This review includes input from a number of teachers and administrators, so that checks and balances are used to analyze the problem.

As the Center develops strategies to address a child's particular problem, a variety of options should be considered, including:

  • Changes to the physical environment
  • The daily structure of activities
  • Consistency
  • Transition times
  • Redirection

Ultimately, Center personnel will attempt a number of approaches before making the final decision to suspend or the disenrollment of a child from the program.

By signing this form you are stating that you have read and fully understand all information above.

Date:(Required)

Lifetime Photograph Authorization

Our program is requesting that our staff and administrators be allowed to photograph children enrolled in the program. There are times during the school year when special activities and events have been planned which enhances the children's experience and participation in class projects.

By signing this you are releasing pictures and allowing Springview Academy to post such pictures on our social media pages and advertising. In case of accident or incident pictures will be used as documentation along with the accident or incident report.

The following are some examples of what we use photographs for:

  • Teaching purposes
  • Our school newsletter
  • To make school albums
  • For memories of special activities
  • Display in classroom and bulletin boards
  • Encourage self-esteem
  • Accreditation criteria
  • Accident report
  • Facebook
  • Instagram
  • Neighborhood Flyers

Please be aware that any photographs taken of your child is for the sole purpose and use of our program

Date

Permission for Food-related Activities & Special Occasion food consuption

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: classroom cooking projects, gardening, school wide celebrations, and birthdays.

I, (Parent or Guardian) give/decline permission for my child to participate in food related activities and special occasions wherein food is consumed.(Required)
(please choose one)
Please provide the following information:(Required)
may not eat or handle the following items (please list all that apply)
Date:(Required)

Handbook Acknowledgement Form

Date:(Required)
This field is for validation purposes and should be left unchanged.