Dear Parents,

Welcome to the Infant Program! Heart 2 Heart know that placing your infant in child care can be difficult. Please be assured that Heart 2 Heart strive to offer your child a loving, safe and stimulating environment that fosters the natural development process. Heart 2 Heart takes special care to provide individualized attention for each child throughout the day. Infancy is an exciting period of growth and development as babies learn how to control their bodies and muscles. Of course all this growing and learning requires lots of eating and sleeping too!

Throughout the year Heart 2 Heart will begin introduce skills to help your child hold his/her own bottle, feed themselves finger foods, sit in a chair to eat, use plates and utensils, participate in songs, story time and more. Each of these skills will be more easily learned if the expectations are consistent between home and school. Please talk with us about what developmental milestones you expect for your child.

This is your child’s first learning environment andHeart 2 Heartencourage your involvement. Good communication between teacher and parent benefits all involved and encourages strong foundations between home and school. Heart 2 Heart thinks it is important to talk to us every morning about your child. For example: What time did your child wake up? What did he/she eat? Please notify us of any concerns, issues or events that may affect your child. Illness, antibiotic treatment, or new living arrangements, etc., can affect your child’s mood. This information can help us to meet your child’s needs in relation to the overall classroom.

Heart 2 Heart is so excited to share this wonderful time of discovery with your child and look forward to working with your family.

Heart 2 Heart

Infant Room Supply List

2 Extra Sets of Clothing (From head to toe)

2 Crib Sheets (1 to be taken home every Friday to be washed and 1 extra)

Bibs (Cloth and Plastic)

Blankets

Burp Cloths(if needed)

Pacifier and Holder (if used by the child)

1 Week Supply of Diapers

Ointments

1 Container of Formula ( if used) / Milk

Baby Food

Baby Cereal

Microwavable Bowl

Tote or Bag (to be taken to and from school)

All Children will have a cubby to store their belongings in. Please label all belongings with FIRST and LAST names so we do not mix up their things.

ALL UNLABELED ITEMS WILL BE LABELED BY THE STAFF

Parent Responsibilities

  1. Please be sure to label all your child’s food, food containers, bottles and cups with both FIRST and LAST NAMES
  2. Please put all perishable foods in the refrigerator in your child’s labeled zip lock bag.
  3. On Fridays or the last day of the week for your child, please bring all sheets / blankets / pillow home to be washed. Return sheets / blankets / pillow on Monday or the first day of the week for your child.
  4. We ask that all children's toys be kept at home unless otherwise advised by your child's teacher. We cannot be responsible for lost or broken toys. We do not allow toy guns, knives, toy swords or any toys of destruction, which encourage violence or aggressive play.
  5. Please let us know of any changes in your family’s routine or illness, antibiotic treatment, etc.that might be effecting your child’s behavior while in our care.
  6. When picking up your children and leaving for the day, please leave as quickly as possible. Remember that the teachers still have responsibilities before they can leave.
  7. Please check in the refrigerator daily and remove empty food containers and food.
  8. Please call if your child is going to be absent
  9. Please be here by 9:00am in order to fully benefit from the routine and learning programs. Toddlers thrive with consistent schedules, so late arrival can be a problem. Sometimes parents allow their child to sleep late in the morning. We know that you have your child’s needs in mind but it is actually less beneficial to allow the extra sleep time. Allowing a child to sleep until 9 a.m. and then arriving at school at 10, only to be offered lunch and afternoon naps at Noon does not present much balance to his/her day. Let us know if your child had a late night and we will make an extra effort to allow them to make up for lost sleep during the day.
  10. Please be sure to check your child’s folder daily as many important notes are sent home. Folder should stay in the backpack.

I authorize the following individual to take my child from Heart 2 Heart premises. (It is advised that you notify the provider at the beginning of the day when your child will be picked up by one of the authorized Individuals.) Please only provide a number if Heart 2 Heart can contact them if they cannot reach you.

1. Name as Appears on Driver License______

  • Number ______

2. Name as Appears on Driver License ______

  • Number ______

3. Name as Appears on Driver License ______

  • Number ______

4. Name as Appears on Driver License ______

  • Number ______

5. Name as Appears on Driver License ______

  • Number ______

6. Name as Appears on Driver License ______

  • Number ______

7. Name as Appears on Driver License ______

  • Number ______

Persons NOT Authorized to Pick Up My Child

  1. ______
  1. ______

Parent/Guardian (Please Print) ______

Parent Signature: ______Date: ______

Medical Emergency Release

Child’s Information

First Name ______Last Name ______

Date of Birth______

Does your child have any medical conditions that the emergency room would need to know about (such as asthma, diabetes, epilepsy and etc.)?Yes No

Is your child on any medication? Yes No

If yes, what is the name of the medication?______

Insurance Information:

Insurance carrier & policy number ______

Doctor's name & phone number______

Dentist's name & phone number______

Medical Emergency Treatment

I, hereby, give Heart 2 Heart Child Care Center permission to administer first aid and/or CPR to my child, ______. Heart 2 Heart or any of its employees has permission to call a physician to secure necessary medical care in the event of an emergency.

I give consent for all medical and/or surgical treatment that may be required for our child during my absence I, hereby, authorize Heart 2 Heart to have my child as listed above treated by any medical personnel, EMTs, paramedics, doctors, or dentist that Heart 2 Heart thinks is necessary (including the administration of anesthesia if surgery is advised by a physician), and to otherwise act in my behalf in order to protect my child when I cannot be reached and/or when delay would be dangerous in case of illness or accident. I also give my consent to have my child transported by ambulance to a medical facility. I understand that I will be responsible for all costs related to such treatment.

I, hereby, acknowledge that no guarantees have been made to me as to the effect of such examinations or treatments on my child's condition. I have read this form and I certify that I understand its contents.

I, hereby, give my consent:

Parent/Guardian (Please Print) ______

Parent Signature: ______Date: ______

NEW YORKSTATE

OFFICE OF CHILDREN AND FAMILY SERVICES

Medical Statement of Child in Childcare

To Be Completed By Licensed Physician, Physician’s Assistant or Nurse Practitioner

Name of Child: / Date of Birth: / Date of Examination:
Immunizations required for entry into day care
Medical Exemption The physical condition of the named child is such that one or more of the immunizations would endanger life or health. Attach certification specifying the exempt immunization(s). / Yes No
Diphtheria, Tetanus and Pertussis (DPT) Diphtheria and Tetanus and acellular Pertussis (DTaP) / 1st Date / 2nd Date / 3rd Date / 4th Date / 5th Date
Polio (IPV or OPV) / 1st Date / 2nd Date / 3rd Date / 4th Date
Haemophilus influenzae type B (Hib) / 1st Date / 2nd Date / 3rd Date / 4th Date OR 1st Date (if given on or after 15 months of age)
Pnuemococcal Conjugate (PCV) for those born on or after 1/1/08) / 1st Date / 2nd Date / 3rd Date / 4th Date
Hepatitis B / 1st Date / 2nd Date / 3rd Date
Measles, Mumps and Rubella (MMR) / 1st Date / 2nd Date
Varicella (also known as Chicken Pox) / 1st Date / 2nd Date

Other Immunizations may include the recommended vaccines of Rotavirus, Influenza and Hepatitis A

Type of Immunization: / Date: / Type of Immunization: / Date:
Type of Immunization: / Date: / Type of Immunization: / Date:
Type of Immunization: / Date: / Type of Immunization: / Date:

Tests

Tuberculin Test Date: / / / Mantoux Results: / Positive Negative / mm
TB Tests are at the physician’s discretion.
If positive, or if x-ray ordered, attach physician’s statement documenting treatment and follow-up.
Lead Screening Date: / /
Attach lead level statement
Lead Screening (Include All Dates and Results)
1 year / / / Result: / mcg/dL / Venous / Capillary
2 years / / / Result: / mcg/dL / Venous / Capillary
Most recent date of lead screening (if different from above):
/ / Result: / mcg/dL / Venous / Capillary
Per NYS law, a blood lead test is required at 1 and 2 years of age and whenever risk of lead poisoning is likely. If the child has not been tested for lead, the day care provider may not exclude the child from child day care, but must give the parent information on lead poisoning and prevention, and refer the parent to their health care provider or the county health department for a lead blood screening test.

Medical Statement of Child in Childcare (continued)

Health SpecificsComments

Are there allergies? (Specify) / Yes No
Is medication regularly taken?
(Specify drug and condition) / Yes No /
Is a special diet required?
(Specify diet and condition) / Yes No
Are there any hearing, visual or dental conditions requiring special attention? / Yes No
Are there any medical or developmental conditions requiring special attention? / Yes No

Summary of Physical Exam

Include special recommendations to Day Care Providers

On the basis of my findings as indicated above and on my knowledge of the named child, I find that: he/she is free from contagious and communicable disease and is able to participate in day care. / Yes No
Signature of Examiner / Address
Please Print Name / City, State, Zip
( )
Title / Phone / Date
Religious Exemptions
Public Health law Section 2164 allows a child to be religiously exempted from immunization. A written and signed statement from a parent, parents or guardian of the child stating that they object of the immunization of their child due to their sincere and genuine religious beliefs should be submitted to the day care owner, operator or administrator who shall determine whether the statement of religious belief is acceptable.

OCFS-6010 (5/2015)

NEW YORK STATE

OFFICE OF CHILDREN AND FAMILY SERVICES

Non-medication Consent Form

Child Day Care Programs

  • This form may be used when a parent consents to having over-the-counterproductsadministered to their child in a child day care program. These products include, but are not limited to: topical ointments, lotions and creams, sprays, sunscreen products and topically applied insect repellant.
  • This form should NOT be used to meet the consent requirements for the administration of the following:prescription medications, oral over-the-counter medications, medicated patches, and eye, ear, or nasal drops or sprays. OCFS Form 7002 would meet the consent requirements for medications.
  • One form must be completed for each over-the-counter product. Multiple products cannot be listed on one form.
  • This form must be completed in a language in which the staff is literate.
  • If parent’s instructions differ from the instructions on the product’s packaging, permission must be received from a health care provider or licensed authorized prescriber.

PARENT TO COMPLETE THIS SECTION (#1 - #14)

  1. Child’s first and last name:
/
  1. Date of birth:
/
  1. Child’s known allergies:

4. Name of product(including strength): /
  1. Amount to be administered:
/
  1. Route of administration:

7A. Frequency to be administered, include times of day if appropriate:
OR
7B. Identify the conditions that will necessitate administration of the product(signs and symptoms must be observable prior to administration):
8A. Possible side effects: See product label for complete list of possible side effects (parent must supply)
AND/OR
8B: Additional side effects:
9. What action should the child care provider take if side effects are noted:
Contact parent
Other (describe):
10A. Special instructions: See package insert for complete list of special instructions (parent must supply)
AND/OR
10B. Additional special instructions:
11. Reason(s) for use(unless confidential by law):
12. Parent name (please print): / 13. Date authorized:
14. Parent signature:
X
DAY CARE PROGRAM TO COMPLETE THIS SECTION (#15 - #21)
15. Program name:
Heart 2 Heart Child Care / 16. Facility ID number:
410322 / 17. Program telephone number:
845 582-0661
18. I have verified that #1, -#14 are complete. My signature indicates that all information needed to administer this product has been given to the child day care program.
19. Staff’s name (please print):
MAT Approved Staff Member / 20. Date received from parent:
21. Staff’s signature:
X

Heart 2 Heart

Child Care Center Contract

Please check that you have received and read my daycare handbook. By checking the box you show that you agree and accept all the rules and regulations that Heart 2 Heart provided you with. It also shows that you will do your best to follow Heart 2 Heart handbook and know that you may get friendly reminders if some of the rules in the hand book are not being followed.

This is a legal and binding contract between Heart 2 Heart and (parent/or legal guardian)

  1. Childcare services will be provided by Heart 2 Heart for (name of child) ______, according to the agreed upon schedule provided.
  2. All Major Holidays will be paid while at the Heart 2 Heart and no childcare service will be provided.
  3. The fee for childcare will be $ per week payable at the beginning of the week.
  4. You agree to pay $25.00 for any check that is returned to me. If a 3rd bounced check occurs all payments for the next 6 months will be made in cash, money order or cashier’s check.
  5. You know and agree to pay all costs that come about because of unpaid debt; Such as money paid out to a collection agency, legal fees and court fees.
  6. You know and agree to provide me with a 2 weeks’ notice prior to any vacation time.
  7. Parent and child care provider both agree to provide 2-week written notice to terminate the Childcare Contract. Parent knows and agrees that if a 2 weeks written notice is not given to provider prior to withdrawal of your child from Heart 2 Heart, then the final 2 weeks fees will still be payable to Provider. *Provider has the right to terminate this contract instantly if your child has caused intentional harm to the other children (such as biting, hitting and kicking, etc) or is purposely destroying property and not following the rules. Such as breaking things on purpose, swearing, not listening to Staff.
  8. All forms need to be filled out before your child can start. Forms will be updated yearly. Parents know that without the proper forms his/her child will not be able to attend until they are all filled out.
  9. Parent agrees to provide all supplies needed by Provider. Parent understands items are not supplied, they will be purchased by Heart 2 Heart and Parent will reimburse Provider for the full cost.
  10. Parent agrees to not drop child off before their schedule times and to pick child up by their schedule times otherwise there will be a fee charged of $1.00 for every minutes early or late unless child is prearranged to arrive early or stay late but must be done 24 hours in advance. If parent is consistently late parent knows that daycare can and will be terminated.

Parent/Guardian (Please Print) ______

Parent Signature: ______Date: ______

Weekly Schedule

M – F

Start Time ______

End Time______

Or

Monday Tuesday Wednesday Thursday Friday

Start Time ______Start Time ______Start Time ______Start Time ______StartTime ______

End Time ______End Time ______End Time ______End Time ______EndTime ______

Parent/Guardian (Please Print) ______

Parent Signature: ______Date: ______

Heart 2 Heart Child Care Center Telephone Directory

I only want the information to be used for teachers contact list.

I give permission for my child’s name and the parents’ information checked to be listed in a directory to be given to families of the children enrolled in the school.

Dad’s Information - ALL

Dad Name ______

Email______

Best Contact Number ______

Mom’s Information - All

Mom Name______

Email______

Best Contact Number ______

Parent/Guardian (Please Print) ______

Parent Signature: ______Date: ______

Student Pictures and Video Usage Policy

Children are photographed or videotaped at Heart 2 Heart for a variety of uses; please check the uses for which you would like to give permission. If there are any special conditions please specify below.

_____ School Use

_____ Newspapers and TV stations

_____ Facebook / Internet

Parent/Guardian (Please Print) ______

Parent Signature: ______Date: ______

Heart 2 Heart Child Care Web Camera Access Agreement

  1. Parent access to this Service is intended to foster comfort and not serve as a surveillance system for events that take place at the Center. Accordingly, Heart 2 Heart is not obligated to archive or otherwise maintain files or other reproduction of the content which appears on the Service for future reference.
  2. You are responsible for the security and use of your password. You must never respond to a request for this password to safeguard your privacy.
  3. You shall not use the Service for any unlawful or inappropriate purpose.

Parent/Guardian (Please Print]) ______

Parent Signature: ______Date: ______

Emergency Plan – Fire Drills

Fire Drills will be conducted using a battery operated smoke detector. The Director will walk from room to room while the smoke detector is engaged to ensure building is evacuated. Evacuation routes and procedures will be posted in each classroom with a map outlining the routes. Each room will take their teacher binders (containing attendance & parent(s) contact information). Pre-School Room teacher will also take emergency suitcase.