RAINBOW CHILD DEVELOPMENT CENTER

Registration Form

Child:
(First) (Last) / Date Enrolled:
Nickname: / Sex: / Date of Birth:
Address: / Home Phone:
Chronic Physical Problems/Pertinent Developmental Information/Special Accommodations Needed:
Previous Child Care Programs and Schools Attended: / Reason(s) for Leaving:
Additional Programs and Schools Attending Concurrently: / Child's Social Security Number:

Parent/Guardian Information

Father: / Place Employed: / Business Phone:
Home Address: / Father's Social Security Number:
Home Phone: / Cell Phone: / E-Mail Address (optional):
Mother: / Place Employed: / Business Phone:
Home Address: / Mother's Social Security Number:
Home Phone: / Cell Phone: / E-Mail Address (optional):
Parent(s) or Agency having Legal Custody of Child:
(Please provide RainbowChildDevelopmentCenter with a copy of custody papers.)

Emergency Information

Allergies or Intolerance to Food, Medication, etc. / Action to take in an allergic reaction emergency:
Child's Physician / Phone:
Person to Contact if Parents Cannot be Reached: / Address : / Phone:
Person to Contact if Parents Cannot be Reached: / Address: / Phone:
Person(s) Authorized to Pick up the Child:
Person(s) NOT Authorized to Pick up the Child*:
*Appropriate paperwork, such as custody papers, must be attached if a parent is not allowed to pick up the child.

Photo Release Authorization

I understand that my child's photo may be taken for inclusion in the local newspapers or the school website or articles/newsletters relating to school activities.
(Please check) Yes □ No □ Legal Parent/Guardian Signature ______

(OVER)

RAINBOWCHILDDEVELOPMENTCENTER

Registration Form

AGREEMENTS

  1. The parent/guardian gives authorization for the child to participate in field trips. You will be notified in advance of any planned trips. Yes □ No □
  2. A parent/guardian must inform the center within 24 hours or by the next business day if your child or any member of the immediate household has developed any reportable communicable disease.
  3. RainbowChildDevelopmentCenter agrees to notify the parent/guardian whenever the child becomes ill, and the parent/guardian agrees to pick up the child as soon as possible.
  4. The parent/guardian authorizes RainbowChildDevelopmentCenter to obtain immediate medical care if any emergency occurs when he cannot be reached immediately.
  5. The parent/guardian agrees to give RainbowChildDevelopmentCenter the appropriate paperwork, such as the custody agreement, if a parent is not allowed to pick up the child.
  6. The parent/guardian understands that RainbowChildDevelopmentCenter is not responsible for incidents that may occur if a staff member is hired to provide outside babysitting services.
  7. The parent/guardian agrees not to hire RainbowChildDevelopmentCenter staff for at home care during hours in which the center is operating.
  8. The parent/guardian agrees to give the center a written two week notice with withdrawing the child from the center or be responsible for the two weeks tuition.
  9. The parent/guardian agrees to abide by the following tuition policies.
  • A registration fee is charged to enroll a child in the program. It is non-refundable and due annually.
  • Tuition payments are due in advance of care on Monday of each week. Payments received after Tuesday will be assessed a late fee of $20.00.
  • A 10% discount will be given when two children from the same family enroll full-time in the center. The discount will apply to the lower tuition fee.
  • There will be a $35.00 charge for each returned check. A money order must be paid for the returned check and all subsequent payments.
  • If an account has to be turned over for any legal collections, the parent/guardian will be responsible for all charges incurred, including legal fees.
  • Center hours are 6:30 a.m. - 6:30 p.m., Monday-Friday. A late pick-up feel will be charged after closing. This fee will be $1.00 for every minute after 6:30 p.m.
  • Children enrolled continuously for one full year in the center, will receive one free week for vacation.

SIGNATURES

______

Parent/GuardianDate

______

Administrator of the CenterDate

OFFICE USE ONLY
IDENTITY VERIFICATION
Place of Birth: / Birth Date: / Birth Certificate #: / Date Issued:
Other Form of Proof: