214 North Main St.
P.O. Box 8122
Moscow, ID 83843
208-882-8176
ENROLLMENT PACKET
CHILD INFORMATION
Full Name: ___________________ Birth date:
_____________
Name used by family or preferred Name:
__________________
Phone: __________ Street Address:
_____________________
City/State/Zip_____________________________________
Parent/guardian name:
________________________________
Address:
____________________Cell: _______________
Occupation:
_____________ Work Phone: _____________
Parent/guardian name:
________________________________
Address:
____________________Cell: _______________
Occupation:
_____________ Work Phone: _____________
Other adult family members in the household-Please
list with relationship to child.
Name Relationship
to child
_____________________ ____________________
_____________________ ____________________
_____________________ ____________________
Children in household-please list in order of
birth (including child enrolled in child care)
Name Sex(M/F) Birth date
________________ _______ ___________
________________ _______ ___________
________________ _______ ___________
________________ _______ ___________
________________ _______ ___________
Has either parent been
divorced?_______Separated?________
Previously married? ________Either parent
deceased? ________
Remarried? _______Custody arrangements?
________________
Is anyone restricted
from seeing the child? If so please list.
Either parent foreign born? __________Where?
____________
What is the dominant language used in the home?
____________
Other languages used in home?
__________________________
Has your child had any
serious illnesses, operations, or accidents? Please describe.
_____________________________________________________________
_____________________________________________________________
Are there any special considerations we should make for your child because of his or her general physical condition? ________
Which hand does your child prefer? ˙Right ˙left
˙both
What word(s) does your child use for urine?
________________
Bowel movement? ______________ Potty trained?
___________
Whom does your child prefer to play with? ˙Alone
˙Other
Children ˙Adults
What types of activities
does your child enjoy sharing with family members?
_____________________________________________________________
List favorite toys and activities.
Indoor Outdoor
______________________ ____________________
______________________ ____________________
______________________ ____________________
______________________ ____________________
______________________ ____________________
List your child’s favorite companions (please
specify if they are real or imaginary)
_______________________________________________
_______________________________________________
________________________________________________
List your child’s favorite and least favorite
foods.
Likes Dislikes
_____________________ ___________________
_____________________ ___________________
_____________________ ___________________
Describe your child’s interest in literacy
activities (reading, writing, and drawing)
________________________________________________
________________________________________________
________________________________________________
________________________________________________
Should we be aware of any other interests,
concerns, or fears that your child may have?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Infant Information
Brand of formula used:
_______________________________
Type of formula used:
________________________________
Feedings are how often?
______________________________
Is it ok to sleep your child on their tummy? ________________
Is a pacifier used?
___________________________________
Are there any special sleeping habits we should
follow? ________
_________________________________________________
Which baby foods are ok?
Cereal? ________________What type: ___________________
Fruits? ________________Vegetables?
__________________
Are crackers ok? ______What type?
_____________________
Are table foods ok?
__________________________________
Allergies or reactions
Do NOT give my child:
____________________________________________
____________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________
Policies:
We abide by
individual parents wishes regarding feeding, pacifiers and all other
areas. EXCEPT we will not give a child
medicine above the documented dose and all medicine must be in its original
container. Bottles are NEVER propped
up; babies are held and rocked while they are fed. Older infants, who are so inclined and capable, are allowed to
hold their bottles – they are either held or placed in a reclining seat – never
are they allowed to “roam” with a bottle or cup.
Medication release form
1. Prescribed medicine can only be administered if we have written permission from the parent/guardian.
2. All prescribed drugs must be in the original
container with the physician’s directions on it.
3. Prescription drugs will not be administered if the
expiration date has passed.
4. Over-the-counter medication can only be
administered if we have written instructions from the parent or physician.
THE FOLLOWING INFORMATION MUST BE COMPLETED BEFORE WE WILL ADMINISTER MEDICATION
Child’s name: _______________________________________
Medical issue:
______________________________________
Medication:
________________________________________
Amount to be given:
__________________________________
Times to be given:
___________________________________
Comments or special
instructions:
____________________________________________________________________________________________________________________________________________________________________________________________________________________
Can this form be used for continuous use of this
medication? Y/N
I AUTHORIZE SMALL STEPS DAYCARE TO ADMINISTER THE
PRECEDING MEDICATION(S) AND OR TREATMENT(S).
Parent/Guardian Signature:
____________________________
Date: ________________
SMALL
STEPS
SUNSCREEN
RELEASE
I give small steps permission to apply the
sunscreen that I have provided to be used as needed. I understand that because of potential
allergies, my child will not have any lotions applied that are not provided by
me.
Child’s Name: ________________________________
Name Brand: _________________________________
Parent Name: ________________________________
Parent Signature: _____________________________
Pick-up Information
Date: ___________
The following people are authorized to pick-up ______________(child’s
name)
Photo ID required
Emergency phone list
1. Contact 2. Contact
Name: __________ Name: ___________
Home: __________ Home: ___________
Work: __________ Work: ___________
Cell: ____________ Cell: _____________
____________________ ____________________
(Parent, guardian
signature) (Parent, guardian signature)
3. Contact 4. Contact
Name: ___________ Name: ___________
Home: ___________ Home: ___________
Work: ___________ Work: ___________
Cell: _____________ Cell: _____________
____________________ _____________________
(Parent, guardian signature) (Parent, guardian signature)
Sick
Child Policy
By State Regulation, children may NOT
come to day care if they are sick. Parents will be contacted to pick up their
child within the hour should the child become ill while at the Center. Parents
will be required to adhere to our Sick Child Policies.
If your child displays any of the following symptoms, you should not send
him/her to the Center. Your child will be sent home if any of these symptoms
develop while your child is at the Center:
* A temperature of 100 degrees or higher.
A child must be free from a temperature of 100 or higher without
medication for a minimum of 12 hours before entering the daycare
* Unexplained diarrhea (2 or more watery stools).
* Severe coughing (causing them to lose their breath or gag or
vomit) not relieved by medication.
* Difficult or rapid breathing, other than diagnosed as asthma
related.
* Yellowish skin or eyes.
* Persistent crusty eyelids with red or pink sclera (whites of
eyes), or green discharge from eyes.
* Unusual spots or rashes on the skin, which may or may not
include itching.
* Infected skin lesions accompanied by drainage with swelling or
redness surrounding the area.
* Loss of appetite (when accompanied by other symptoms).
* Listless or cranky behavior (when accompanied by other
symptoms).
* Persistent dark urine accompanied by poor fluid intake.
* Inability to urinate and/or discomfort when urinating.
* Pain or discomfort for extended periods, in any part of the
body.
* Red, sore throat, patches on throat, trouble swallowing.
* Headache or stiff neck, when accompanied by a temperature of 100
degrees or higher.
* Ear aches or pulling at the ear, with an elevated temperature of
100 degrees or higher.
* Persistent green discharge from the nose, with an elevated
temperature of 100 degrees.
* Vomiting and/or upset stomach not caused by activity.
* Tiny bugs or white eggs in hair must receive prompt treatment.
All eggs must be removed from the hair before returning to the center.
·
Any contagious diseases or
illnesses.
Billing Information
Small
Steps Childcare and Preschool
214
N. Main St.
P.O.
Box 8122 Moscow, ID 83843
208-882-8176 1smallstep@pull.twcbc.com
Age Monthly Daily ˝ Day**
0 to less than 2yrs. 575.00 30.68 16.87
2 to less than 3yrs. 525.00 28.41 15.63
3 to less than 5yrs. 475.00 26.14 14.38
**(˝ day fees are four hours or less)
Registration Fee 45.00
PRESCHOOL RATES 50.00 registration fee
2 days a week 144.00 per month
3 days a week 192.00 per month
4 days a week 224.00 per month
Full time childcare parents will only need to bring the items on the supply list and will be charged an extra 50.00 per month.
Hourly Rate 12.50 per hr. (approved drop-in only)
These rates include Breakfast, AM Snack, Lunch, PM
Snack Formula and baby food for Infants.
Parents must provide any special formula or food needs.
Based on Christian values, we promote a secure and warm home-like environment. We offer a large covered outdoor play area and our children get fresh air at least once daily. Our structured daily routine includes pre-k Learning activities, infant sensory and physical activities. We have daily exercises that encourage large motor skills (jumping, hopping on one foot, skipping) and small motor skills (writing, crafts, blowing bubbles, coloring, painting).
Our center is always open to parents/guardians. We strive to be a fun, comfortable and secure place where your children can have a family atmosphere. We also offer parent education on infant and toddler health, growth and development.
Field Trips—Parents will be notified one month in advance of any field trips and the cost per child. If you want your child to participate, he/she must be 3yrs and over and have a signed permission slip.
Our center is open Monday-Friday 6:30am to 6:00pm
*If your child needs to stay with us over 10 hours you will be charged for the extra time at an hourly rate, which we will include, in your monthly bill.
If you have additional questions we would be happy to talk to you anytime, feel free to call!
Thank You,
Rick and Kelley Parsons, Directors
Small Steps Childcare and Preschool
208-882-8176
214 N. Main
P.O. Box 8122
Moscow, Id 83843
Child Care Contract
I have read and understand the enrollment packet and agree to adhere to all the policies stated in the packet.
My child will be in daycare on these days between these hours
Monday________ Tuesday_________ Wednesday________
Thursday________ Friday___________
With a cost of $__________Per Month/Day/˝ Day
Payments are due bi-monthly on the 1st and the
16th and a minimum payment of two weeks in advance before care can
begin. Late
fees of 10% of your balance will be assessed after 5 days from billing for all
past due balances. If you suspect you will be late picking your
child up, you must call and let us know.
Please remember we are a business and we close promptly at 6 PM. A late fee of 15.00 plus 2.00 a minute will be assessed for
pickups after 6.
If you prepay for child care several months in advance and you leave the childcare center before the end of the prepay period then there is a 50% surcharge on your account balance. The remaining balance, after the surcharge is applied, will be re-paid to you 30-60 days after what would have been your original end date.
I agree to pay the
$45.00 registration fee plus two weeks in advance and will pay Small Steps
Childcare on the 1st and the 16th of every month. I understand that I must give Small Steps a 30 day written notice in the event of
cancellation of this contract. I
also understand that all unpaid balances will result in suspension or
termination of care after seven days.
_________________________________________Parent/Guardian
__________________________________Rick or Kelley Parsons, Directors
________ Month_____ Day_______ Year
Date Signed