Child’s Name Birthday
Child’s Name (2nd) Birthday
Child’s Name (3rd) Birthday
Mother’s Name SS#
Address Birthday______
City Zip E-mail ______
Employer
Home phone Work phone Cell phone
Father’s Name SS#
Address Birthday______
City Zip E-mail ______
Employer
Home phone Work phone Cell phone
Child lives with:
Both parentsSister or Brother not attending our center
Single parent (please name) Name Age
Other (please name) Name Age
Two persons who will assume responsibility for your child if you cannot be reached:
1. Name
Relationship
Home phone Work phone Cell phone
2. Name
Relationship
Home phone Work phone Cell phone
Medical Care:
Doctor’s Name Clinic Phone
Allergies or other concerns:
Person(s) authorized to pick up your child:
Person(s) NOT authorized to pick up your child:
If someone other than those listed above will pick up your child, you MUST let the Director know in advance,
preferably in writing. We will not permit your child to leave unless we have permission from you. Please
remind guests to bring a picture ID.
Your tuition of $ will be paid each Monday for that week’s childcare.
Part time tuition of $7.00 per hour will be paid each Monday for the prior week’s childcare.
Payment arrangement follows:
Where did you hear about Kids Kastle? _____Friend/Referral. Who can we thank? ______
Parent’s Signature Date
Beginning child care services will be provided at Kids Kastle, Inc for .
Our program operates primarily on the tuition received from each child’s enrollment. Please pay your bill in a timely fashion so we may pay your child’s caregivers.
Refunds are not given for center holidays or days the child is absent. Sick care is not available. It is the parent’s responsibility to make substitute arrangements. Please refer to your handbook for our sick child policy.
Each full time family is eligible for 10 days vacation credit each year (January – December) after 6 months of full time enrollment. Credits are for full time families only. If you choose a part time schedule any time during the year, you forego any eligibility for vacation credit. Please notify the Center Director one week prior to the vacation so staffing can be adjusted.
A two week written notice to the Director is required to withdraw a child from the program. Parents are responsible for the contracted rate for the two weeks, even if our services are not used.
When a change of hours, days, or payment is needed, a new contract is required as soon as possible. This is to ensure adequate staffing.
Parents arriving after the center closes must pay the late fee of $5.00 per child per quarter hour. Parents must notify the center if they are delayed beyond their scheduled arrival time. Three late pick-ups may be cause for discontinuance of child care services.
If payment becomes delinquent per the agreement on the application, you will incur a $10.00 late fee. If it becomes necessary to refer this account to a credit collection agency, the parent is responsible for any fees associated with this collection.
Program Choices
A. Economy program (maximum 10 hours childcare per day)
$142.00 per week ages 4 weeks to 1 year
$136.00 per week ages 1 year to 3 years
$132.00 per week ages 3 years and up
10 days vacation credit for full time children can be taken after attending Kids Kastle for six continuous months
B. Standard program (available for 3 year old and older-based on availability)
$7.00 per hour – minimum of $60.00 a week. Fees are based on a full hour rate.
We MUST have your child’s schedule for the upcoming week by Friday at noon to include days and hours of attendance. Bills will be calculated by these schedules and even if your child does not attend Kids Kastle on a scheduled day, the parent will pay in full for the contracted hours.
Any family that uses Kids Kastle over 25 hours in a week is considered full-time and will be charged the appropriated economy program rate for the age of the child.
C. School-age program
$60.00 per week for Grades K and up during the school year. If school is out you will be charged the economy rate of $132.00 for that week.
$60.00 a month transportation fee
Fees
Registration is $35.00 plus $15.00 for each additional child payable upon registration. This is a non-refundable fee.
A mat fee of $28.00 is also charged upon enrollment. These two fees must be received prior to your child’s first day.
There is a $30.00 material fee per child per year payable 1-15 September.
I choose the A/ B/ C program. I have received the Kids Kastle Parent Handbook. I (we) understand and agree to abide by the policies and procedures as stated in the Parent Handbook and the above childcare contract and admission forms. Occurrences which are contrary to this contract will invalidate the contract and be cause for dismissal of the child from the program. I also understand from time to time the Director may implement or change policies as needed. I understand I will be notified of such changes in writing.
Parent’s Signature Date
Director’s Signature Date
Permission at Kids Kastle, Inc for to participate in activities and receive medical care.
I hereby grant permission for my child to use all the play equipment in all the activities of the center, and to leave the center premises under the supervision of a staff member for neighborhood walks or for field trips in an authorized vehicle.
Please note: permission forms will be provided prior to special field trips such as touring local interest points.
I hereby grant permission for the Director or Acting Director to take steps necessary to obtain emergency medical care. These steps may include, but are not limited to, the following:
- Attempt to contact parents or guardian, the child’s physician, or the persons listed on the admission form.
- If we cannot contact you or your child’s physician, we will do one or both of the following:
• Call another physician or paramedics
• Have the child taken to an emergency hospital in the company of a staff member
- Any expense incurred under step 2 will be borne by the child’ family.
- The Center will not be responsible for anything that may happen as a result of false information given at the time of enrollment.
- The center will not assume responsibility for a child who has not been signed in upon arrival for the day.
Medical Authorization and Release
The undersigned, who are the parents or guardians having legal custody of the above named minor, hereby authorize Kids Kastle, into whose care the minor has been entrusted, to consent to an X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care to be rendered to said minor under the general or special supervision and upon the advice of a physician and surgeon licensed under the provisions of the Medical Practice Act or by a dentist licensed under the provisions of the Dental Practice Act.
The undersigned further authorizes Kids Kastle to have the above named minor released into the custody of its representative should hospital care no longer be required.
This form is to be used ONLY in an extreme emergency, when said parents or guardians cannot be or are unavailable to be contacted.
Due to state laws and regulations we are no longer able to administer any over the counter medications to your child(ren) without your written consent. This also includes the use of bug sprays, sunscreen and antibiotic ointment. We will be providing these items to students who have completed the following consent form, please initial your choice.
_____ Yes, I give permission to Kids Kastle Staff to apply bug spray, sunscreen and antibiotic ointment to my child(ren).
_____ No, I do not give permission to Kids Kastle Staff to apply bug spray, sunscreen and antibiotic ointment to my child(ren).
_____ I will be providing bug spray, sunscreen and antibiotic ointment for the Kids Kastle Staff to apply to my child(ren).
Child’s Media Release
I grant permission for my child’s picture to be taken by newspaper photographers, television reporters, etc. visiting the Center or while on a field trip.
Sick Child Policy
In order to maintain a healthy environment, we ask that you not bring your child to Kids Kastle if he/she is showing signs of illness. Bringing a child with any of these symptoms to the Center may cause others to get sick. If all parents keep ill children at home, everyone’s child will remain healthier.
Symptoms that would warrant your child to stay at home:
• A temperature of over 101 degrees (auxiliary)
• Discharge from ears or eyes
• Vomiting or diarrhea lasting over several hours (3 within one hour)
• Any rash or skin lesions that blister
• Excessive signs of cold, tiredness, sore throat, runny nose, sneezing or coughing.
Kids Kastle staff are instructed NOT to accept a child from the parent if they are showing any of these symptoms. The child may return to the Center 24 hours after the symptoms are clear and are not medicated to prevent a fever. A doctor’s note stating the child is not contagious is also acceptable.
Parent’s Signature Date
Facebook photo release
I grant permission for my child(ren)’s picture to be taken by a Kids Kastle employee exclusively on the Kids Kastle camera to be posted on the Kids Kastle Inc. Facebook page. No information beyond my child(ren)’s first name and classroom will be used.
______
Child(ren)’s Name
Yes, Kids Kastle may post my child(ren)’s photo
No, Kids Kastle may not use my child(ren)’s photo
______
SignatureDate
- Economy program (maximum 10 hours childcare per day)
$142.00 per week ages 4 weeks to 1 year
$136.00 per week ages 1 year to 3 years
$132.00 per week ages 3 years and up
10 days vacation credit for full time children can be taken after attending Kids Kastle for six continuous months
- Standard program (available for 3 year old and older)
$7.00 per hour – minimum of $60.00 a week. Fees are based on a full hour rate.
We MUST have your child’s schedule for the upcoming week by Friday at noon to include days and hours of attendance. Bills will be calculated by these schedules and even if your child does not attend Kids Kastle on a scheduled day, the parent will pay in full for the contracted hours.
Any family that uses Kids Kastle over 25 hours in a week is considered full-time and will be charged the appropriate economy program rate for the age of the child.
- School-age program
$60.00 per week for Grades 1 and up during the school year. If school is out you will be charged the economy rate of $132.00 for that week.
$60.00 a month transportation fee
Fees
Registration is $35.00 plus $15.00 for each additional child payable upon registration. This is a non-refundable fee.
A mat fee of $28.00 is also charged upon enrollment.
These two fees must be received prior to your child’s first day.
There is a $30.00 material fee per child per year payable 1-15 September.
08/08/2012