Peace United Methodist Preschool

Peace United Methodist Preschool

235 Diley Road North, Pickerington, Ohio 43147 • (614) 837-3732 (614) 837-9722 Fax

June 11, 2015

Dear Parents,

We are very excited about the upcoming year of preschool this fall! This will be our 12thyear of providing an outstanding preschool program to the community and surrounding area! We hope you and your child are as eager as we are. We at Peace Preschool are thrilled that you chose our program. As we look forward to the beginning of school, there are a few items that need to be in your child’s file before the first day of school.

Please return the following forms before or by August 10, 2015:

1) Child Enrollment and Health Information Form (this form you may have filled out at registration.)

2) Authorization for Pick-Up Form

3) Signed Receipt of Policies and Procedures Form

4) Signed Routine Field Trip Form

5) Child’s Medical Statement Form-this form is required by the State of Ohio and must be signed, dated and stamped by a physician and on file within thirty days of the first day of school. (This is different than a copy of immunization)

Here is a list of important dates:

1) September 1, 2015 September Tuition due: (If paying by check, make check out to PUMC with preschool tuition written in the memo. You may also set up with your bank direct payment to the preschool.) You may pay in the church office or drop off your payment in the tuition box outside my office door in the Children’s Wing.)

$160.00 –MTWTH class

$140.00-MWF classes &TWTH class

$110.00-TTH classes and MW class

2) September1, 2015 Drop in and see the preschool room and meet the teacher with your preschooler anytime between:

11:00-12:00 MWF am &TWTH am class meet the teacher

12:00-1:00 MW am MWF pm & MTWTH pm class meet the teacher

1:30- 2:30 TTH am class

2:30- 3:30 TTH pm class

3) September 1, 2015 @ 7:00pm-Parent Orientation, this will be only for parents. At this orientation, parents will meet the teachers, and review school policies.

4) September 2, 2015 (9:00-11:30 A.M. or 12:30-3:00P.M.) First day for MW am class MWFam and pm classes, TWTHam class and theMTWTH pmclass

5) September 3, 2015(9:00-11:30 A.M. or 12:30-3:00 P.M.) First day for TTH am and pm classes.

(When you bring your child to school, take a short time to say goodbye. Give your child a kiss, reassure your child that you will be back, and then exit. This gives the teachers the opportunity to begin to establish their trust and relationship with your child. If there are a few tears, please be aware that these are usually over quickly. It is usually harder for the parents to make the separation than for the child to make the adjustment.)

If you have any questions or concerns about the upcoming year, please contact me.

Thank you and see you real soon,

Jill Kilgore

Peace U.M. Preschool Director

Ohio Department of Job and Family Services

CHILD ENROLLMENT AND HEALTH INFORMATION

FOR CHILD CARE CENTERS AND TYPE A HOMES

This form shall be completed prior to the child's first day of attendance and updated annually and as needed.

Child’s Name / Date of Birth / First Day at Center
Home Address / City
State / Zip Code / Home Telephone Number
Parent/Guardian Name / Relationship to Child
Home Address / Home Telephone Number
City / State / Zip
Email Address (if applicable) / Cell Phone
Parent's Work/School Telephone Number / Parent's Work/School Name
Parent's Work/School Address / City
Please indicate if this name should be released if a parent/guardian, of a child attending the center/home, requests contact information for other parents/guardians. Yes No
If you answered yes, please indicate which number(s) above to include on the listWork # Cell #Home # Email
Where can you be reached while your child is in this program?
Parent/Guardian Name / Relationship to Child
Home Address / Home Telephone Number
City / State / Zip
Email Address (if applicable) / Cell Phone
Parent's Work/School Telephone Number / Parent's Work/School Name
Parent's Work/School Address / City
Please indicate if this name should be released if a parent/guardian, of a child attending the center/home, requests contact information for other parents/guardians. Yes No
If you answered yes, please indicate which number(s) above to include on the listWork # Cell #Home # Email
Where can you be reached while your child is in this program?
Emergency Contacts: Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Name / Name
City / State / City / State
Telephone Number / Relationship to Child / Telephone Number / Relationship to Child
Other numbers where emergency contact can be reached (if applicable) / Other numbers where emergency contact can be reached (if applicable)
Name of Physician or Clinic/Hospital
Street Address
City / State / Telephone Number
Child’s Name
Allergies, Special Health or Medical Conditions, and Food Supplements
Fill in this section accurately and completely. Please note that if your child has a current health or medical condition requiring child care staff to perform child specific care, such as: to monitor the condition, provide treatment, care, or to give medication, the JFS 01236 "Medical/Physical Care Plan" or equivalent form and/or the JFS 01217 "Request for Administration of Medication" must be completed and be kept on file at the center or type A home.
Does your child have any food, medication or environmental allergies? (check all that apply)
No
Yes - check all that apply Food Medication Environmental Please list and explain:
Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child? (check one)
No
Yes - a JFS 01236 "Medical/Physical Care Plan" or equivalent form and if administering medication, a JFS 01217
"Request for Administration of Medication" must be completed.
Does your child have a special health or medical condition? (check one)
No
Yes - please explain
Does the special health or medical condition require child care staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during child care hours? (check one)
No
Yes - a JFS 01236 "Medical/Physical Care Plan" or equivalent form and if administering medication, a JFS 01217
"Request for Administration of Medication" must be completed.
Is your child currently using any medication, food supplement or medical food (such as electrolyte solution)? (check one)
No
Yes - please explain
If yes, does this medication, food supplement, or medical food need to be administered at the child care center/type A home?
No
Yes - a JFS 01217 "Request for Administration of Medication" must be completed and kept on file for each medication, food supplement or medical food.
N/A - program does not administer any medications.
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons? (check one)
No
Yes - please explain
Does this dietary restriction require a modified diet that eliminates all types of fluid milk or an entire food group?
No
Yes - written instructions from the child's health care provider must be on the JFS 01217 "Request for Administration of
Medication."
N/A - child does not attend a full time program.
Child's Name
List any history of hospitalization, outpatient surgery, or previous health concerns that would be needed to assist the staff or medical personnel in an emergency situation.
List any additional information about your child that would be useful for staff to know, such as fears, eating or sleeping habits, or special routines. This information should not be medical or health related, as that information should be included on the previous page.
Diapering Statement
Is your child toilet trained? Yes (If yes, skip to Emergency Transportation Authorization section) No (If no, fill out the following)
The program's policy is to check diapers every hours. Please indicate if you want your child's diaper checked according to the center/type A home's policy or another:
I agree with the program's schedule I do not agree, please check my child's diaper every hours.

Emergency Transportation Authorization

Give Permission to Transport / OR
Do not
sign
both / Do Not Give Permission to Transport
Center or Type A Home Name / Center or Type A Home Name
has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported. / does not have permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. I wish for the following action to be taken:
Parent's Signature / Date / Parent's Signature / Date
Acknowledgement of Policies and Procedures
I have reviewed and received a copy of the center's or type A home's policies and procedures/handbook. Yes No
(check one)
This form, after being completed and signed by the parent/guardian, must be reviewed for completeness and signed by the administrator/designee prior to the child receiving care. After the child is attending the program the administrator shall have the parent/guardian review and initial the form when any changes/updates are made and at least annually. The parent/guardian and the administrator or designee shall initial and date the form in the section below to indicate when the form was last reviewed.
Parent/Guardian Signature(s) / Date
Administrator/Designee Signature / Date
The form is to be initialed and dated, at least annually, after it has been reviewed by the parent/guardian. This is to indicate all information has stayed the same or changes have been noted. If significant changes are needed, please complete a new form.
Parent/Guardian Initials / Date of Review / Administrator/Designee Initials / Date of Review
Parent/Guardian Initials / Date of Review / Administrator/Designee Initials / Date of Review
Parent/Guardian Initials / Date of Review / Administrator/Designee Initials / Date of Review

Form 2

Peace U. M. Preschool Authorization for Transportation

I authorize the following person(s) to pick up my child from preschool. I understand it is my responsibility to notify the preschool in writing of any changes. Your child will be released only to the individuals listed below unless a signed written note has been provided to your child’s teacher. Please notify the people on your list as well as any one you authorized in a written note that photo ID will be asked for by the teacher prior to releasing your child. .

(Please Print)

STUDENT’S NAME:______

PARENTS’/GUARDIANS’ NAMES:______PHONE #______

Name:______phone:______Relationship______

(Please check if applies)

_____ I have given a copy of legal custody papers to the preschool office which indicate the following biological parent/guardian MAY NOT pick up the child listed. ______

Will your child attend PDO on Fridays?______. If yes, I give PDO teachers permission to pick up my child and walk them to the PDO or Preschool room.

I do here authorize Peace United Methodist Preschool to release my child to the above listed people in event I am unable to pick up my child myself. I release Peace United Methodist from any and all responsibility for problems that may develop when such persons take my child from the premises.

Signature of Parent/Legal Guardian:______Date:______

Form 3

Signed Receipt of Policies and Procedures Form

This form must be on file before the first day of school

I acknowledge that I have received a copy of the parent handbook for Peace U.M. Church Preschool and have reviewed the preschool policies. I agree to follow all the policies outlined within.

Signature of Parent/Guardian Date

Routine Trip Destination(s) / Around Peace U.M church grounds including the
lacrosse practice fields below the back parking lot
Date of Permission (valid for one year) / 9/1/2015 – 9/1/2016
Mode of Transportation
Walking; teachers have cell phones with them.
No water activities are planned during this walk.
Child’s Name:
I grant permission for my child to participate in the routine trips described above.
Parent’s Signature: / Date:

Ohio Department of Job and Family Services

CHILD MEDICAL STATEMENT FOR CHILD CARE

Child’s Name (print or type) / Date of Birth
This above named child has been examined, the immunization status recorded, and the child is in suitable condition for participation in group care.
Signature of Examining Physician/Physician'sAssistant/Advanced Practice Nurse/Certified Nurse Practitioner / Date of Examination
Name of Physician/Physician's Assistant/Advanced Practice Nurse/Certified Nurse Practitioner / Telephone Number
Street Address
City, State and Zip Code

ATTACH A COPY OF THE CHILD'S IMMUNIZATION RECORDWITH DATES OF DOSES OF ALL IMMUNIZATIONS

Diseases for Immunization / PHYSICIAN /PHYSICIAN'S ASSISTANT/ADVANCED PRACTICE NURSE/CERTIFIED NURSE PRACTITIONER COMPLETES
check all that apply for each disease
Immunized / In Process of Immunization / Medically Contraindicated/
Not AgeAppropriate
Chicken pox
Diphtheria
Haemophilus influenzae type b
Hepatitis A
Hepatitis B
Influenza
Seasonal Vaccine Not Available
Measles
Mumps
Pertussis
Pneumococcal disease
Poliomyelitis
Rotavirus
Rubella
Tetanus
I have declined to have my child immunized against one or more of the diseases required by 5104.014 of the Ohio Revised Code. Initial beside the disease(s) being declined above and sign below.
Signature of Parent / Date of Signature
Recommended Assessments/Screenings
Vision / Yes No / Lead / Yes No
Hearing / Yes No / Hemoglobin / Yes No
Dental / Yes No / Other
Measurements: / Notes:
Height
Weight
BMI

PEACE UNITED METHODIST PRESCHOOL

235 Diley Road

Pickerington, OH 43147

(614) 837-3732

(614) 837-9722 Fax

1.INFORMATIONABOUT OUR PRESCHOOL

Peace Preschool was founded by Peace United Methodist Church in 2003 as part of its Christian Outreach to the community. All children are welcome…..it is unlawful to discriminate in the enrollment of children on the basis of race, color, religion, sex, national origin, or disability in violation of the Americans with Disabilities Act of 1990. Peace Preschool is licensed by the state of Ohio and the license is posted in classroom 4. The laws and rules governing child care are available at the school for review upon request. A requisition may be made to the Ohio Department of Job and Family Services to view our Fire, Building, and ODJFS inspections. The telephone number for ODJFS is (614) 466-7765. The number may be called to report a suspected violation of Chapter 5104 of the Revised Code or Chapter 5101:2-12 of the Administrative Code.

2. AGES, DAYS, AND HOURS OF OPERATION

Calendar: Peace Preschool begins September 2, 2015 and is in session until May 13, 2016. Please look at our school calendar for holidays and other days we are not in session.
Snow Days: If Pickerington Local Schools are closed for snow days, Peace Preschool shall also be closed. Listen to local TV and radio stations for cancellations. Peace Preschool does NOT follow Pickerington School delays. If Pickerington Schools are delayed, Peace Preschool will have the following schedule: AM session 10:00 -11:30 and PM session 12:30- 3:00. Loss of school days due to conditions beyond our control will not be made up nor fees adjusted.
PLSD Two hour Late Start: We will not follow these developmental days. Preschool will maintain its same school hours.
Age Groups: Three Year Olds as of August 1, 2015 attend Tuesday and

Thursday 9:00 a.m.-11:30 a.m. or 12:30 p.m. –3:00 p.m. or Monday and

Wednesday 9:00 a.m. – 11:30 a.m.

Four Year Olds as of August 1, 2015 attend Monday, Wednesday, and Friday 9:00 a.m.-11:30 a.m. or 12:30 p.m. - 3:00 p.m. or Tuesday, Wednesday, and Thursday 9:00 a.m.-11:30 a.m.

Four ½ & Five Year Olds (5 by February 1, 2016 and not attending Kindergarten) may attend Monday, Tuesday, Wednesday and Thursday 12:30 p.m.-3:00 p.m.

3. STAFF

The Peace Preschool staff is trained to provide a safe environment for your child. Their technique of handling children in a warm, sensitive, and loving manner will encourage the development of the whole child. All Lead teachers hold a degree in Early Childhood or Elementary Education. The entire staff sees themselves as doing ministry by being positive role models for young children. The staff participates in in-service workshops pertaining to child development or early childhood education. Also, at least one staff member on the premises is trained in CPR, First Aid, Communicable Diseases, and Child Abuse. The staff is required by law to report any suspicions of child abuse or neglect to the Fairfield County Children’s Service. The ratio of staff/child will be in compliance with the guidelines set forth by the Ohio Department of Job and Family Services. That ratio is one staff member for every twelve three year olds, and one staff member for every fourteen four and five year olds. Group sizes shall not exceed twice the maximum number of children allowed per child care staff member as required in the staff/child ratio section of this rule. Our total license capacity for any one time is 55 children.

4. REGISTRATION

Our registration is first open to our Preschool families and Parent’s Day Out Ministry families, then to our church family of Peace United Methodist Church, and finally to the public.There is a non-refundable registration fee of $75.00. This fee is NOT applied to the first month tuition. Registration generally begins in February.

5. PHILOSOPHY

Peace Preschool provides a safe educational environment in which Christian values and attitudes are developed. Our program is child-centered. Children are encouraged to be creative and to explore the environment through hands-on -centers. Through a mixture of guided and undirected activities, children will have the opportunity to learn about colors, shapes, numbers, letters, and other basic readiness skills as well as creative concepts such as “pretend” play, art, and music.The preschool experience will strive to meet each child’s needs and stimulate his/her learning physically, socially, emotionally, and intellectually. The activities are designed to encourage the child’s self-confidence, a concern for others, co-operation in work and play. We will work jointly with the child’s primary educator the parents to promote growth of their preschooler.