Little Eagle Child Care Center
250 Murall Dr. #900
Kearneysville, WV. 25430
Phone 304-264-7132 Fax 304-264-7017
Returning Families Only
Summer camp registration will begin April 2, 2018.
To secure your spot a completed enrollment packet along with the registration and activity fees must be turned in to the main office.
Space is limited and is based on a first come first served basis. Registration packets will be available March 26, 2018 and may be picked up at the main office or obtained from our web site littleeagle.org
To be announced to August 15, 2018 * to inquire about fees please call 304-264-7752
*Subject to change according to school closing
Important!
Please Read Now
Thank you for your interest in the Little Eagle summer camp. Please be aware our Summer Camp is first come first serve. Your packet, registration and activity fees must be returned to secure a spot. If you have an outstanding balance with Little Eagle you must bring your account current before you can register for Summer Camp.
Welcome to the Little Eagle Child Care Family!
We are so pleased that you have chosen our Summer Camp! If you ever have any questions, suggestions, or input please stop by the office or drop us a note in the tuition box. Here is a list of numbers within our center for your convenience.
VA Center (Camp Location)…………. (304) 263-0811 x4776
Main Building…… ………………………… (304) 264-7132
Office (Lisa Berry) …………………………. (304) 264-7752
***At the start of camp you will receive a security code, please enter code exactly as given to gain access into LECCC. Please do not give your security code to anyone other than those who you want to have access to your child/children. Thank you for helping us to keep your little one(s) safe and secure as we can.
Summer Camp 2018 Information
Hours of Operation –
Monday - Friday 6:30 – 6:00
Camp dates: To Be Announced – August 15, 2018 Children –
Ages 5yrs that have completed Kindergarten to 12yrs
Cost –
$168.15 per week
$ 45.00 per day
$ 30.00 Registration fee
$ 50.00 Activity fee
Food –All meals are included or you may send a daily nutritious packed lunch and snack.
* No soda please
Our Policies –
- Enrollment is on a first come first served basis.
- There will be a $30 fee for all returned checks.
- LECCC is not responsible for lost, late, or misdirected mail.
- You are paying for your child’s spot, not their attendance. No make-ups, refunds or credits will be given for missed classes.
- Please mark your calendar. No confirmation or reminders will be sent, you are only notified if there is a problem processing your registration or if class is cancelled.
- LECCC reserves the right to take pictures at all events and programs, Pictures may be displayed in future Little Eagle brochures and publications.
- Please visit our website, We are regularly updating our information so please check back.
Signature: ______Date: ______
Tuition Agreement
Please complete information requested, Sign, Date and Return this Form.
Tuition Payment Procedures:
All payments are to be made in advance by Friday PRIOR to child care services rendered for the following week. There are three tuition programs available to parents of children at the Center. Regardless of the payment plan you choose, your payment to tuition must always be made in advance. For example: if you choose the weekly plan, your payment must be received in the payment box Friday before the following Monday; if you choose the bi-weekly plan, your payment must be received in the payment box Friday before the following two weeks; if you choose the monthly plan, your payment must be received in the Payment box Friday before the following month. (If you choose the monthly plan, do not pay for a partial week at the end of the month. Instead, you must count all the Mondays in the month and pay as total weeks.)
Please choose one of the following plans
- ______Weekly $ ______Tuition
- ______Bi-Weekly $ ______Tuition
- ______Monthly $ ______Tuition
** Note: Payments must be received before services are rendered. All tuition fees are based on a 40 hours work week. Additional fees will apply for more hour usage. Cost per day will be adjusted to accommodate special work schedules.
*** There will be a $30.00 charge for each non sufficient funds check returned to LECCC in addition to the original amount of the check. This is due immediately upon notice or child care services will be denied. Only money orders will be accepted at that point. Any account that has a balance past due will receive a reminder for payment. If payment has not been received according to the date given in the reminder, child care services will be terminated immediately.
If you are late picking up your child (after building closes at 6:00pm) you will be charged based on the rate of the classroom. Authorities will be notified if the teacher has not heard from you. Consistent lateness will be cause to ask you to withdraw your child from the center.
Tuition Agreement
REGISTRATION FEE: A registration fee of $30.00 is due at the time of enrollment. If you withdraw and then re-enroll your child, you will be charged another $30.00 fee.
CHILD CARE HEALTH FORM AND IMUNIZATIONS:
Upon enrollment and every year after, you must submit to LECCC a child care health form signed by a physician. Immunizations are to be updated as they occur. Children will not be accepted for enrollment without these.
WITHDRAWL:
Two weeks prior written notice, or two week’s tuition is payable upon child’s withdrawal from the program. There are instances when group care is not in the best interest for all children. Either party may anytime give a two week notice to cancel care. The pay arrangements still apply.
I hereby agree to comply to all rules and regulations of Little Eagle Child Care Center regarding fees. Attendance, health, parking and to all other items specified in the “Parents Handbook” received at the time of my child’s enrollment.
Child’s Name ______DOB: ______
Home Address: ______
City: ______State: ______Zip Code: ______
Parent’s Name: ______
Parent’s Employer: ______
Work # ______Work # ______
Home # ______Home # ______
Tuition Agreement
PLEASE STATE BELOW THE EXACT HOURS THAT YOU NEED TO BRING CHILD/CHILDREN TO OUR CENTER AND EXACT HOURS THAT YOU WILL PICK UP YOUR CHILD/CHILDREN FROM OUR CENTER. This will enable us to schedule staff accordingly and determine whether you will have additional fees for using more than 40 hours per week.
My child/children will attend LECCC at ______am and be picked up from LECCC at ______pm.
Please check the days you need child care services. These will be your scheduled days and you may not alter without prior written request to the LECCC office and permission is granted.
_____ Monday ____ Tuesday _____ Wednesday _____ Thursday _____ Friday
Date of Enrollment ______
Parent’s Signature: ______Date ______
______Date ______
Director Of LECCC Signature ______Date______
Emergency Information
Child’s Name: ______Gender______
Child’s Birthday: ______
Home Address: ______
Mother’s Name: ______Home Phone: ______
Mother’s Employer/School______
Work #: ______Cell #: ______
Hours of Work ______Days Off ______
Father’s Name: ______Home Phone: ______
Father’s Employer/School: ______
Work #: ______Cell #: ______
Hours of Work: ______Days Off: ______
People Authorized to Pick Up Child (Daily)
Name:______Relationship: ______
Phone: ______Cell: ______
Name: ______Relationship: ______
Phone: ______Cell: ______
When Parents Cannot Be Reached; List Person(s) To Pick Up Child In An Emergency
Name: ______Phone: ______
Cell: ______Address: ______
Name: ______Phone: ______
Cell: ______Address: ______
Name of Child’s Physician: ______Phone: ______
Address: ______
List All Allergies/medical conditions:______
List all medications:______
Preferred Hospital For Emergency Care: ______
**** For those EMERGENCIES requiring immediate medical attention, your child will be taken to the nearest hospital emergency room.
______
Signature Date
Emergency Form / Medical Authorization
Name of Child: ______Date of Birth: ______
Address: ______Phone: ______
Mothers Name: ______Home Phone: ______
Mother’s Employer or School: ______
Business Phone: ______Hours of Work: ______Days off: ______
Father’s Name: ______Home Phone: ______
Father’s Employer or School: ______
Business Phone: ______Hours of Work ______Days off: ______
Medical Insurance Company: ______
Group # : ______Subscriber’s Name: ______
Subscriber’s SS # ______-______-______
Other Relatives to be contacted if unable to reach parents:
Name/Relationship: ______Phone: ______
Name/Relationship: ______Phone: ______
Child’s Physician: ______Phone: ______
Child’s Dentist: ______Phone: ______
I hereby grant permission for my child, the above name minor, to use all the play equipment and participate in all the activities of the school, and to leave the premises under the supervision of a staff member for neighborhood walks or for field trips in authorized vehicles.
I hereby grant permission for the Director or Acting Director to take whatever steps may be necessary to obtain emergency medical care. These steps may include, but are not limited to the following:
- Attempt to contact a parent or guardian, the child’s physician, or the person listed on the emergency information form.
- If we can not contact you or your child’s physician, we will do one of both of the following:
a. call another physician or paramedic
b. have the child taken to an emergency hospital in the company or of a staff member.
- Any expenses incurred under item #2 will be done by the child’s family
- The school will not be responsible for anything that may happen as a result of false information give at the time of enrollment.
- The child care center WILL NOT assume responsibility for a child who has not been signed in upon arrival for the day.
The undersigned, who are parents or guardians having legal custody of the above named minor, herby authorize Little Eagle Child Care Center, Inc., In whose care the above named minor has been entrusted to rendered to said minor under the general or special supervision and upon the advice of a physician or surgeon licensed under the provisions surgical diagnosis or treatment, and hospital care to be rendered to said minor by a dentist licensed under the provisions of the Dental Practice Act.
The undersigned further authorize the Little Eagle Child Care Center, Inc., to have the above named minor released into the custody of his/her representatives should hospital care no longer be required.
This for is to be used ONLY in an emergency, when said parents and guardians can not be or are unavailable to contact.
______
Signature of Mother or Legal Guardian Date
______
Signature of Father or Legal Guardian Date
Release Form
I, ______give my permission for my child(ren), ______
______to have their photos taken at this facility. I also give my permission for audio/video recordings of my child to be made. I understand that photos may be used for public relations materials produced by LECCC Inc. and/or IRS/ECC or media coverage for our center.
I give my permission for my school age child enrolled at LECCC to participate in all water play activities including swimming if and when provided to LECCC’s school age program. I also release the VA Medical Center and Little Eagle Child Care Center of any negligence on behalf of the certified life guard.
If I supply sunscreen/sun block for my child(ren), I give my permission for the LECCC employees to apply the sunscreen/sun block.
______
Parent/Guardian Signature Date
______
Director Signature Date
SPECIAL DIETARY NEEDS
PHYSICIAN’S MEDICAL STATEMENT
Name______Date of Birth______
Does this patient have a medical condition/disability that affects her/his diet? ____Yes ____ No
Did you refer this patient to a dietitian for diet consultation? _____ Yes _____ No
If yes, please indicate the consulting dietitian: Name______Phone ______
Diagnosis or Medical Condition ______
PLEASE MARK ALL AREAS BELOW THAT APPLY, SIGN AND DATE.
DIET RESTRICTIONS Day Total Breakfast Lunch Snack
Caloric Requirements 1200 ______
1500 ______
1800 ______
2000 ______
Other (Specify Calories) ______
Carbohydrate Counting (Specify Milligrams) ______
Sodium Restrictions (Specify Grams) ______
Fat Restriction ______
Cholesterol Restriction ______
Other Restrictions ______
FOOD ALLERGIES SUBSTITUTION
Food(s) Patient CAN NOT Have Substitutions MUST BE Listed
______
______
______
TEXTURE CONSISTENCIES
Solids Liquids
Regular Chopped ______Regular _____
Mechanical Soft Nectar/syrup _____
With ground meat ______
Mechanical Soft Honey _____
With chopped meat ______
Pureed ______Pudding _____
Nutritional supplements to be provided at school or site please specify amount and frequency of feeding
Oral Feedings ______
Section 504 of the Rehabilitation Act of 1973 assures disabled individuals’ access to meals. If an individual has a disabling condition that limits on or more major life activities and requires a special diet, a physician’s statement is required. Schools or sites may make substitutions for non-disabled individuals who are unable to consume the regular meal because of medical or other special dietary needs. A statement from a recognized medical authority, eg., medical doctor (MD), doctor of osteopathic medicine (DO), registered nurse(RN), physician’s assistant (PA), nurse practitioner (RNC) or registered dietitian(RD), is required.
______
Name &Title (please Print) Signature Date
Special Meal Accommodations/Modifications
Date: ______
______Child Care Center believes that you and your childs’ physician are the experts on your child’s health needs. Therefore, the Center requires authorization from your child’s physician before making adjustments to the meals your child will be served during their attendance at the center. A Special Diet Statement must be completed by your child’s physician for the program to withhold any meal component from your child. According to the Center’s policies, Parents are responsible for providing special food accommodations and alternatives if your child is unable to follow the Center’s regular meal options.
In the event that a child has a diagnosed disability, the Center will aid in meal modifications based on information provided by your child’s physician. US Department of Agriculture (USDA) regulations require that the Center be provided with a signed statement form a licensed physician specifying the following:
- That the participant has a disability as described in the federal definition of “handicapped person.”
- Which “major life activity” is affected by the child’s disability.
- That the disability restricts the participant’s diet.
- The food or food items to be OMITTED form the diet, and the food or choice of foods that MUST be substituted.
Please check one and sign below:
My child does not have a diagnosed disability. I understand that it is my responsibility to have a Special Diet Statement signed by my child’s physician detailing any foods that my child cannot consume. I also understand that it is my responsibility to provide these necessary meal accommodations for my child.
My child has a diagnosed disability and I will provide a written statement from child’s
physician outlining the information listed above. Upon receipt of this signed statement, I understand that the Center will provide meal accommodations for my child. I understand that I have 15 business days from the above date to return this documentation to the Center.
______
Parent Signature Date
______
Parents Signature Date
Little Eagle Child Care Center
250 Murall Dr. #900
Kearneysville, WV. 25430
Phone (304) 264-7132 Fax (304) 264-70
Summer Camp communication link via Email
This summer LECCC would like to establish communication between staff and parents by using email. This will provide weekly updates on our summer activities, any changes or cancellations of field trips, or statement information. Please provide your name, child’s name, and an email address that we can use. All addresses will be kept private and only used for summer camp related topics.
Thank you
Name______
Childs Name______
Email(s)
(Please Print Clearly)
1.______
2.______