ID # ______
Little Rascals Child Care Learning Center
ALLERGIES
Child’s Name: ______
Allergy: Yes No
Allergy to:
Food: ______
Medication: ______
Other: ______
Parent/Guardian Name ______
Parent/Guardian Signature ______Date: ______
187 Miller Place Yaphank Road
Miller Place, New York 11764
631 474-7080
Emergency Form
We/I______give our permission to
(Parent’s name)
Little Rascals Child Care Learning Center to obtain emergency
health care and emergency transportation for our
son/daughter______in the event of accident or
(Childs’s name)
illness.
I do not give my permission
______
(Parents signature) (date)
ID # ______
Little Rascals Child Care Learning Center
CHILD ILLNESS POLICY
- If your child has a fever over 100 degrees, is vomiting, has 2 loose bowel movements or has any unexplainable skin rash, he/she must be picked up from the center immediately and remain home for 24 hours before returning to Little Rascals.
- Please keep your child home if they have cold symptoms, which prevent participation in the program, if your child has a deep bronchial cough, and if your child is medicated to the extent that he/she falls asleep or is very irritable.
- If a doctor has put your child on antibiotics, he/she must have been taken them for 24 hours before he/she may return to the center.
- Your child must be free from communicable diseases listed on the attached schedule.
- As a licensed childcare provider, we are required to obtain a Physician’s note for certain types of injury or illness and all medications to be administered to your child. Parents will be notified in these cases.
- For your child’s safety, we require that parents notify the director in writing of any allergy or medical condition your child has or develops. This allows us to properly record and distribute the information to necessary staff.
These standards are to ensure the health and safety of
All the children and staff within the center.
We appreciate your support.
I understand and agree to the above safety procedures for my child.
Parent/Guardian Name ______
Parent/Guardian Signature ______Date: ______
ID # ______
Little Rascals Child Care Learning Center
Infant Information Form
Child’s Name: ______Date: ______
Schedule
Eating: Times: ______
Amounts: ______
Foods/Formula Given Warm or Cold: ______
Dietary Restrictions: ______
Sleeping: Times: ______
Routine: (Blanket, rocked, pacifier) ______
Position Preference (back or side) ______
Elimination: Recommended Times to Change: ______
Powder/Cream/Ointment: ______
Times to use: ______
Recent changes in family routine or environment that may affect your child: ____
Indications of developmental, vision, hearing, or speech delays: ______
Please specify: ______
Language other than English spoken at home: ______
Medications: ______
Comments: ______
We/I ______give our permission to Little Rascals Child Care Learning Center to let our son/daughter______sleep on a mat during Nap time. We understand that our child will be napping on a mat in their classroom during napping hours.
We/I do not give permission for our child to sleep on mat.
We/I give permission for our child to sleep on a mat.
Parents Signature______Date______
ID # ______
Little Rascals Child Care Learning Center
Parent Authorization Form
Child’s Name: ______Date of birth: ______
Parent/Guardian Name: ______Today’s Date: ______
Little Rascal’s staff may use the following products, which I have provided and which are clearly labeled, on my child:
Please place a check next to each Item (authorized or not authorized)
Product Authorized Not Authorized
Diaper OintmentDiaper Wipes
Diaper Powder
(Talc Free)
Baby Lotion
Sunblock
Chapstick
I understand that photographs of my child will be used for school events only. Photographs for any other purposes will
not be used unless permission is granted.
Parent/Guardian Name ______
______
Parent/Guardian Signature Date
Little Rascals Child Care
Learning Center
Parent Handbook Receipt
This acknowledges that you are in receipt of Little Rascals Child Care Learning Center’s Parent Handbook which includes: our school philosophy, program information, schedule of your child’s day and our centers illness policy. If you have any questions on any information that was proved to you feel free to speak to our director or owner.
Child’s Name______
Parent/Guardian Name:______
Parent/Guardian Signature: ______Date:______
ID # ______
Little Rascals Child Care Learning Center
Personal Childhood History
Child’s Name: ______Date of Birth: ______
Sleeping Habits______
Eating Habits______
Toilet Habits______
Siblings Names and Ages______
Child Disposition______
Additional Comments______
ID # ______
Little Rascals Child Care Learning Center
Personal Childhood History
Name: ______
Date of Birth: ______
Members Of The Household (Including Parents)
Name / Age / RelationshipPersonal History
Parent(s) that live in the household: ______
Pets:
Names: ______
Type: ______
Has your child had any other group or school experiences? ______
Child’s Special Interests: ______
Does your child speak in sentences? ____Does your child speak in words? ____
Does your child have a difficulty in speaking? ______
Any special services? ______
Any other languages spoken at home? ______
Special words to describe your child’s needs? ______
How do you discipline your child? ______
______
______
Health History
What arrangements can you make for care during illness? ______
______
Doctor’s Name: ______Phone #: ______
Insurance Carrier: ______ID #: ______
Please provide the center with a copy of your child’s Insurance card. Received_____
What communicable disease has your child had?
Please
MeaslesMumps
Chicken Pox
Whooping Cough
Other
Describe:
Other
Describe:
Has your child ever has any serious illness or hospitalization? ______
______
Preferred Hospital? ______
Any Physical disabilities? ______
How does your child react to elevated temperatures? ______
Any special instructions of your child becomes ill? ______
Are there any medications given regularly? ______
Eating Habits
Is your child normally hungry at mealtimes? ______
Is your child normally hungry between meals? ______
What are your child’s favorite foods? ______
What foods are refused? ______
What eating problems does your child have? ______
Are there any special diet instructions? ______
Does your child use eating utensils? ______
Toilet Habits
Does your child indicate his/her own toileting needs? ______
What words are used for urination and bowel movements? ______
Is your child afraid of the bathroom? ______
How much assistance does your child need with toileting? ______
When was toilet training started? ______When Accomplished? ______
Is your child in underwear? ______Pull-ups? ______
Does your child wet the bed during naptime? ______How often? ______
Sleeping Habits
What time does your child go to bed? ______Awaken? ______
Does your child walk, talk, or cry during sleep? ______
What does your child usually take to bed? ______
Does your child take naps? _____ From: ______To: ______
What is your child’s mood upon awakening? ______
Social Relationships
Has your child had any experience in playing with other children? ______
______
By nature is your child…
FriendlyAggressive
Shy
Withdrawn
Other
Describe:
Other
Describe:
How does your child get along with any brothers or sisters? ______
Does your child like to be alone? ______
How does your child relate to strangers? ______
Does your child demand a lot of attention? ______
What causes your child to be angry or upset? ______
How does your child show feelings? ______
What do you find is the best way to handle your child? ______
Is your child afraid of…
AnimalsRough Children
Darkness
Storms
Other
Describe:
Other
Describe:
What are your child’s favorite toys or activities at home? ______
Does your child like to be read to? ______
Does your child like to listen to music? ______
Does your child prefer to play outdoors? ______
Has your child had
Experience with…
ClayScissors
The Easel
Blocks
Finger Paint
Water Play
Additional Notes or Comments
In what way can we help your child? ______
Briefly describe your child’s personality and abilities: ______
Thank you for sharing this helpful information with us so we can better understand the individuality of your child!
Parent/Guardian Name ______
Parent/Guardian Signature: ______
Little Rascals Learning Center
187 Miller Place Yaphank Road
Miller Place, New York 11764
631 474-7080 Phone
631 474-7084 Fax
Shelter in Place
New York State now requires all daycare centers to practice Shelter in Place drills.
Shelter in Place is a response to an emergency that creates a situation in which it is safer to remain in the building rather than to evacuate. Generally, Shelter in Place means simply staying indoors. In some situations, sheltering in place includes additional precautions like locking all doors, closing all window shades, remaining in a room away from large windows or turning off heat and air conditioning systems. Some situations that might require sheltering in place are: severe weather, extreme temperatures, a public disturbance that escalated to violent acts, chemical or biological spill, etc.
In the event that our center has an emergency that requires us to shelter in place you will receive an email immediately, followed by a phone call explaining the situation at hand.
If the emergency requires the children to stay overnight, it is important to have supplies for each child. The state is requiring that each child have a supply of food/water in the event we should have to stay overnight. Please bring a zip lock bag, labeled with your child’s name, a non-perishable food item and bottle of water. If you have an infant, please provide extra formula/baby food in a zip lock bag clearly labeled with their first and last name.
We all hope to never experience an emergency, but it is better to be fully prepared and ready just in case of the event of having to shelter in place. Thank you for your cooperation.
Amanda Kolm- Director
Jacquelyn Amorello-Assistant Director
Little Rascals Learning Center
187 Miller Place Yaphank Road
Miller Place, New York 11764
631 474-7080 Phone
631 474-7084 Fax
Tuition Payments Based On Contract
Please read Carefully
Please be aware that tuition is based on your contract not on attendance. If you are out sick or on vacation you still are responsible for your tuition. Please understand our teachers are still paid and your child is taking up a spot in the class. If you need to withdraw from a program please provide proper notification to avoid penalties.
Please be aware that exceptions will not be made to this policy.
Child’s Name______
Parent’s Name______Date______Signed______
187 Miller Place Yaphank Road
Miller Place, New York 11764
631 474-7080 Phone
631 474-7084 Fax
Please read carefully
I am aware that Little Rascals Child Care Learning Center requires no long-term commitment. In order to end a weekly program, I only need to provide Two Week Written Notification to theDirector. At this time your two-week deposit, which was left upon registration, will be applied to the last two weeks your child attends the program. If your deposit does not cover the cost of the tuition, due to a change in schedule or tuition rate, you will then be responsible for paying this difference upon this notification.
Please be aware that exceptions will not be made to this policy.
Child’s Name______
Parent’s Name______Date______Signed______