Enrollment Package

www.RainbowChildrensAcademy.com

1213 Centinela Avenue

Inglewood, Ca 90302

(310)672-2400 – Main (310)672-4100 Fax

Enrollment Package

Our Mission

Providing the SAFEST, most LOVING

EDUCATIONAL environment for your children

www.RainbowChildrensAcademy.com

1213 Centinela Avenue

Inglewood, Ca 90302

(310)672-2400 – Main (310)672-4100 Fax

Welcome to Our School

Thank you for choosing Rainbow Children’s Academy as your child care provider.

Our goal is to always provide our students with the safest and most loving educational environment. As a state licensed facility, we have met or exceeded all health and safety guidelines. We practice and teach cleanliness and are here, not only to educate, but to praise and encourage your child’s growth and development.

Our attentive staff addresses each student respectfully. We are an experienced team. We’re recommended by other parents of the program as well as parents of children who have now moved on to higher education.

Please understand, it is required that you fill out all documents in this package. Please, use black or blue ink and accurately fill out all information carefully, and legibly.

Open communication is very important to us. Our wonderful staff is here to answer any and all questions you may have. Please, feel free to call or email anytime. We will be more than happy to help.

Welcome to our community,

Staff@ Rainbow Children’s Academy

www.RainbowChildrensAcademy.com

1213 Centinela Avenue

Inglewood, Ca 90302

(310)672-2400 – Main (310)672-4100 Fax

□  / ·  Meeting with one or both parent /guardians and the child/children with our enrollment representative for a brief interview.
□  / ·  Physician’s Report (Filled out and Signed by Child’s Doctor)
□  / ·  Copy of your child’s immunization record YELLOW CARD
□  / ·  Copy of your child’s birth certificate (used to verify the child’s birth date and your relationship)
□  / ·  Copy of your California Driver’s License
□  / ·  First week’s tuition payment and Uniform Fees due on your child’s 1st day of school
□  / ·  Annual registration fee is $250.00
□  / ·  All state payment assistance forms (i.e. Crystal Stairs Program) We will assist you with filling out the necessary forms

* Please make sure all forms in this packet are filled out in BLACK or BLUE INK*

www.RainbowChildrensAcademy.com

1213 Centinela Avenue

Inglewood, Ca 90302

(310)672-2400 – Main (310)672-4100 Fax

Emergency Information Card

Child’s First Name: / Child’s Last Name: / Child’s Date of Birth:
_____/ _____/_____ / Current Age:
Mom’s First Name: / Mom’s Last Name:
Dad’s First Name: / Dad’s Last Name:
Home Address: / City: / State: / Zip:
Home Phone: / Mobile Phone: / Work Phone: / Email:
Emergency Contact #1: / Main Phone:
Emergency Contact #2: / Main Phone:
Please List All Known Allergies
1. / 2. / 3. / Date of last
Tetanus Shot:
I hereby give the following individual(s) the authority to pick up my child.
Individual #1: / CDL No: / Day Phone: / Eve Phone:
Individual # 2: / CDL No: / Day Phone: / Eve Phone:
Signature of Parent/ Guardian:
Signature:______Dated:______/______/______

www.RainbowChildrensAcademy.com

1213 Centinela Avenue

Inglewood, Ca 90302

(310)672-2400 – Main (310)672-4100 Fax

Services & Financial Agreement (Contract)
Child’s First Name: / Child’s Middle Name: / Child’s Last Name:
Child’s Date of Birth:
__ _ _ /______/______ / Child’s Current Age:
Home Address: / City: / State: / Zip:
Home Phone: / Mobile Phone: / Email:
Sibling: / Sibling’s age:
Sibling: / Sibling’s age:
Please note: Payment for tuition is due on the first day. If payment is late, a five dollar per day fee will be assessed.
I need childcare for my child or children on the following day(s) and times.
Please circle all days of service that apply. / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
From:_____:_____am/pm / To:_____:_____am/pm
FOR OFFICE USE ONLY
Date turned in:
__ _ _ /______/______ / Received By:
Start date:
__ _ _ /______/______ / Registration Paid:
YES NO
By entering my information and my signature below, I hereby state that I have fully read and agree with the terms and conditions stated in this contract agreement (and Parent/ Student handbook) and hereby apply for enrollment of my child and or children in Rainbow Children’s Academy.
Mom’s First Name: / Mom’s Last Name:
Ca. Drivers License: / CDL Expiration Date / Social Security No:
Home Address: / City: / State: / Zip:
Home Phone: / Mobile Phone: / Email:
Employer: / Work Phone:
Employer’s Address: / City: / State: / Zip:
Dad’s First Name: / Dad’s Last Name:
Ca. Driver’s License: / CDL Expiration Date: / Social Security No.:
Home Address: / City: / State: / Zip:
Home Phone: / Mobile Phone: / Email:
Employer: / Work Phone:
Employer’s Address / City: / State: / Zip:
Mother’s Signature:
______Date:_____/_____/______
Father’s Signature:
______Date:_____/_____/______

Please
Initial / Consent and General Terms & Conditions
□  / All children enroll in Rainbow Children’s Academy on a two week trial basis. During that period, either party may end the contract without notice. Beyond that a (1) one-week notice is required.
□  / Should I decide to withdraw my child from Rainbow Children’s Academy, I agree to give the school a (1) one-week notice in writing prior to withdrawing. If this (1) one-week notice is not given, then I agree to pay an additional (1) one-week of tuition.
□  / I understand that payment installments that are NOT received by the designated due dates will be considered delinquent, and as a result, Rainbow Children’s Academy reserves the right to demand payment in full for the current month before further attendance will be permitted.
I understand that my obligation to pay tuition is unconditional and this agreement acts as a legally binding contract between myself ( i.e. the parent or legal guardian) and Rainbow Children’s Academy.
□  / Children will not be permitted to remain in school for more than one week without all fees being paid and brought current.
□  / I understand that in the event Rainbow Children’s Academy must retain the services of an attorney to enforce the terms and conditions of this contract, then I, the child’s or children’s parent/ guardian agree to pay for all related costs and fees (i.e. including legal fees) incurred by Rainbow Children’s Academy.
□  / I understand as the parent/guardian, it is my responsibility to make sure my child’s tuition is PAID IN FULL and kept current by the appropriate due date. I also understand Rainbow Children’s Academy DOES NOT mail out bills or invoices.

Permission to Photograph

I, ______

(parent’s or guardian’s name)

give permission for Rainbow Children’s Academy to photograph my child,

______

(child’s name)

for the following purposes:

Type of Use:
Select to Decline Permission / (X)
Still Photographs:
Display in provider’s personal scrapbook
Give photographs to current clients
Display in facility’s scrapbook or bulletin boards, shown to current and prospective clients
Display on facility’s website /social media
Use still photos in promotional materials
Videos:
Videos for current parents
Display video on facility website/ social media
Use videos in promotional materials
Other (please list):

( ) I’ve made no selections to decline permission.

I understand that it is my responsibility to update this form in the event that I no longer wish to authorize one or more of the above uses. I agree that this form will remain in effect during the term of my child’s enrollment.

Signed:

(parent or guardian signature, and date)