Parent Interview/ Application Form€¦ · Web view1. It’s About Time Children’s Center. 2 Minto Ct. Centereach, NY 11720 (631) 676-6075. [email protected]

IATCC 2016-2017 Service Contract

This agreement is made by and between It’s About Time Children’s Center and _______________________, Parent/Guardian of _____________________________________. Child’s name

Parents name

The following has been agreed upon between the two parties on ________________ for the term of ______________ to ____________, Services will be rendered ____ days a week with a drop-off time of _________ to a pickup time of ________ except on noted Holiday/Vacation time. The weekday(s) of care will be (circle all that apply): Mon Tues Wed Thur Fri .

The term specified amounts of $_________ per week due at latest one business day before services begin for the week. A one-time registration fee of $50.00 and an annual $75.00 materials fee will be charged upon entering into contract. Acceptable forms of payment are Cash or Check. Returned checks will be subject to a $50 fee and future payments must be made by cash.

A deposit of $_______, which is two weeks tuition, has been placed to hold the child’s space in the daycare and will be applied toward the last two weeks of the term. Late fees are $10.00 per day and after two weeks will result in the termination of this contract. The deposit can be refunded with two weeks’ cancellation notice before service term date begins.

Early drop-off and late pickup which are considered out of hours of this agreement but within the hours of operation are subject to a $15 fee per incident per half hour and must notify the center the day before for early drop-off and two hours before for late pickup.

Scheduled vacations are charged at half of normal rate provided two weeks’ notice. Extreme cases such as medical emergencies do not require prior notice and will be charged at half the normal rate.Please initial next to each item. We want to be sure you understand and agree to these policies.

________ I/we understand that I/we must provide a completed Medical form and up to date immunizations (unless I have provided a waiver) to the daycare. Please note parent must provide the childcare with updated immunizations 2-4 times a year.

________ I/we understand all of the daycare fees applicable and that additional fees may apply for special activities such as admission for field trip/or other events at which time we will require prior consent.

________ I/we understand that provider’s illness or emergency will result in no charge.

________ I/we understand daycare payment is due by 6:00pm on the Friday before the new week of childcare begins. It’s About Time Children’s Center2 Minto Ct.Centereach, NY 11720(631) [email protected]

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________ I/we understand the Pick Up policy for other than parental pick up and I will provide copies of licenses of all parents who will be picking up my child including parents, family and friends.

________ I/we have reviewed and understand the Illness policy.

________ I/we have reviewed and understand the Meal policy.

________ I/we understand that there may be activities in which the provider will transport children to an activity. The provider has a valid NYS Drivers’ License and registered vehicle and I will provide a state regulated child safety seat appropriate for my child.

________ I/we are contracting for (year round, school year, summer, other) arrangements.

________ I/we understand the Behavior policy and have shared the daycare rules with our child.

________ I/we have reviewed and understand IATCC’s disenrollment policy. ________ I/we understand the Fee policies.

________ I/we understand the Holiday, Vacation and Absence policies and have a copy of the Holiday and Vacation dates.________ I/we agree to pay the last two weeks tuition during the first two weeks of enrollment.

________ I/we understand that this facility is a pet friendly site and has pets on the premises. Children have access to pets and will help in caring for pets with adult supervision and hand washing will occur after children touch pets. ________ I/we have read and agree to all contents of the contract and that disregarding these policies can result in termination from child care enrollment.

THIS AGREEMENT WHOLLY STATES THE OBLIGATIONS OF THE PROVIDER; THERE ARE NO OTHER IMPLIED OBLIGATIONS. ANY AMENDMENTS TO THIS AGREEMENT MUST BE IN WRITING AND SIGNED BY BOTH PARTIES. **BOTH PARENTS MUST SIGN OR PARENT/GAURDIAN WITH SOLE CUSTODY OF THE CHILD:

___________________________________ ________________Parent/Guardian Date

___________________________________ ________________Parent/Guardian Date

It’s About Time Children’s Center2 Minto Ct.Centereach, NY 11720(631) [email protected]

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Contact and Emergency Information

Date______________________

Child’s Name/nickname ______________________________________Child’s Birthday______________________ Age __________________Address___________________________________________________

Contact Info:

Mom’s name___________________Home Phone #________________Dad’s name____________________Home Phone #_______________ (Mother) Cell Phone____________________Work#_______________ Can you accept text messages? Yes / No(Mother Email) _____________________________________________

(Father) Cell Phone ___________________ Work #_______________ Can you accept text messages? Yes / No(Father Email) _____________________________________________

Emergency Contact Person/relationship_______________Phone#_______________

Emergency Contact Person/relationship_______________Phone#_______________

Do you have a backup care provider?____________________________If so, Name and Phone Number:________________________________

Service Info:

Beginning date care is needed ________________

Hours:

Drop off _____ Pick up______


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Monday ________ to __________ Tuesday ________ to __________ Wednesday ________ to __________Thursday ________ to __________ Friday ________ to __________

Your Child’s Health

CHILD'S HEALTH RECORD: (Please provide a copy of your child's immunizations and current physical using our form) Doctor’s name ________________________________________________________Doctor’s Address ________________________________________________________Doctor’s phone number ___________________________________________________

Are your child's immunizations up to date? ______ If no, do you have a waiver for vaccines?_____________________________

Does your child have any known allergies? Is there a family history we should be aware of? ____________________________________________________________________________________________________________________________________________

Does your child have any medical conditions which I should be made aware of? ________________________________________________________________________________________________________________________________________________________________

Has your child had the following common childhood illnesses?.(please circle or indicate other issues in the space below)

Does your child have any or has had problems with any of these? Has your child had any of these diseases?

Constipation AsthmaSeizures BronchitisDiarrhea Chicken PoxFainting Spells DiabetesFrequent illnesses Heart DiseaseFrequent Ear Infections HepatitisFrequent Sore Throats Impetigo


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Lice MeaslesRingworm MumpsSkin Rash/eczema German MeaslesSoiling PolioStomach Upsets Scarlet FeverUrinary ProblemAnxiety Tuberculosis

Worms Whooping Cough

Does your child have or has ever had any speech, hearing or visual problems? ________________________________________________________________________________________________________________________________________________________________

Does your child or has your child ever received Early Intervention or CPSE services?If so please explain…________________________________________________________________________________________________________________________________________________________________

Are there any restrictions to play or activities? If so please explain… ________________________________________________________________________________________________________________________________________________________________

About Your Child Has your child ever been in child care before?_________ If so, what type (center, family daycare, grandma etc.)_________________________Was it a positive experience?______________________________________________

Why are you looking for child care?_________________________________________How does your child feel about daycare and being left by his/her mommy/daddy? ______________________________________________________________________

Are there any recent traumatic situations the child has been exposed to such as a death in the family, divorce, new sibling etc.? ______________________________________________________________________

What is your normal method of discipline?__________________________________________________________________________________________________________


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What is your child's temperament? Are they easy going, hard to please, demanding, aggressive, etc. ____________________________________________________________________________________________________________________________________________

Are there any food restrictions?_____________________________________________

Can your child be relied upon to indicate bathroom wishes?______________________What words does your child use for: Bowel movements _____________Urination_______________ What time does your child awaken? _________________________________________What time does your child go to sleep at night? ________________________________Do they sleep through the night?_____________________________________________Does your child sleep in a bed or crib, other?___________________________________Does your child nap? If so what time does your child typically nap?__________________ Are there any siblings? Please name them and specify ages and gender.Name _____________________ age __________________ gender _______________Name _____________________ age __________________ gender ______________Name _____________________ age __________________ gender ______________Has your child had experience playing with other children? ________________________________________________________________________________

________________________________________________________________________________ What language(s) are spoken at home?

________________________________________________________________________________

Does your child have any security objects such as a blanket, bottle, toy etc. ?

________________________________________________________________________________

________________________________________________________________________________

What are your child's favorite activities, toys, books, or games? ________________________________________________________________________________________________________________________________________________________________It’s About Time Children’s Center2 Minto Ct.Centereach, NY 11720(631) [email protected]

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Are there any other comments or information you would like to let me know about? ________________________________________________________________________________

How did you hear about us?__________________________________________________________

Any specific concerns?______________________________________________________________

________________________________________________________________________________


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PICK UP AUTHORIZATION FORMThe following people are authorized to pick up my child(ren) from the supervision of my child care provider:

Please provide a copy of each person’s license, this is a REQUIREMENT before returning this form

**Please be aware authorized people will need to furnish a valid driver’s license or ID card that is in accordance with the one on file. The child will not be released unless this is make available to the provider.

1. Name: ________________________ 1. Name: _____________________________

2. Address: ________________________ 2. Address: ____________________________

_______________________________ _____________________________________

3. Phone#: ________________________ 3. Phone # ____________________________

1. Name: ________________________ 1. Name: _____________________________

2. Address: ________________________ 2. Address: ____________________________

_______________________________ _____________________________________

3. Phone#: ________________________ 3. Phone # ____________________________

Parent/Guardian Signature: ________________________________________ Date: _______________________

Signature of Provider: ____________________________________________ Date: ______________________


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SLEEPING ARRANGEMENT AGREEMENT

I UNDERSTAND that my child, ____________________________________, will sleep/rest on/in a:

____ Cot ____Mat ____Crib ____Bed ____ Bassinet

Area where Child will nap: ____ Napping Room A

***A child under 2 years of age will sleep in a pack and play (in accordance with state regulations) the Parents are responsible for providing the Pack and play. **The pack and play MUST be no larger than 40 inches by 28 inches by 29 inches due to space constraints.

All doors to the sleeping/napping area will remain open at all times. If the provider is not in the same room as

the children when they are sleeping, a functioning electronic monitor will be used to with written parental permission.

If an electronic monitor will be used the provider will physically check on my child every 15 minutes.

Please Initial

_____ I UNDERSTAND that my child will be sleeping/resting in the napping/rest room with his/her peers while the provider is in another room using a functioning electronic monitor. The provider will always remain on the same floor as my child._____ I UNDERSTAND that my child if under the age of 2 will be sleeping in a pack and play, I will provide a pack and play no larger then 40’ by 28 by 29’.

Signature of Parent/Guardian: ______________________________________ Date: ________________________

Signature of Provider: ____________________________________________ Date: ________________________


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SUPERVISION OF SCHOOL AGE CHILDREN

I give my permission to my school age child (age 5+), _______________________, to occasionally participate in activities out of the direct supervision of the caregiver (ie. Reading books in another room, outside play-where they can be seen from a window). Such activities will occur on the premises of the child care facility. A caregiver will visually check my child every 15 minutes. My child is able to toilet independently; therefore he/she will use the bathroom for short periods of time without direct visual supervision.

______ My child is not yet school age.

Signature of Parent/Guardian: __________________________Date: __________

Signature of Provider: _______________________________ Date: ___________

Name_______________________________________________

PERMISSION FOR PHOTOGRAPHS AND VIDEO TAPINGPLEASE INITIAL

_______ I consent for my child __________________________________, to be photographed/videotaped for entertainment purposes of school projects.

_______ I consent for my child _________________________________, to be photographed and I agree IATCC can use my child’s pictures for promoting the business.

_______ I consent for my child to be videotaped and I agree IATCC can use my child’s videos for promoting the business.

_______ I consent for my child’s care provider/s to send me text messages, pictures and emails.

I understand that I can rescind my authorization at any time as long as I notify “It’s About Time Children’s Center” in writing within a two week period to allow for changes to occur.

Signature of Parent/Guardian: _______________________ Date: __________Signature of Provider: ______________________________ Date: __________It’s About Time Children’s Center2 Minto Ct.Centereach, NY 11720(631) [email protected]

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FEE AGREEMENT

Child’s Name ______________________________________ Agreement Period __________to ____________

Bi weekly tuition fee : ______________________________________

Expected attendance days: __________________ Hours: _________________________

In consideration of Child Care Services received, I agree to pay a bi-weekly tuition based on the current fee schedule approved by It’s About Time Children’s Center. I understand that this obligation continues until my child is officially withdrawn from the Center.

My financial obligations will include the following:

1) An annual registration fee of $50.00 is due upon acceptance of an opening in the child care center. 2) An additional late fee of $10.00 per day will be assessed if payment is not received by 6pm on the Friday prior

to the new tuition period. 3) An administrative fee of $50.00 will be charged for all returned checks or insufficient funds in your account,

and in addition, fees will also be uncured in accordance with the late fee policy. 4) If a child is picked up after the end of your shift on any given day, you are responsible for paying a late fee

which starts at $15.00 for the first 30 minutes and after that it is $5.00 for every 5 minutes late beyond that. 5) Regular biweekly tuition is due regardless of a holiday, center closing, emergency closings or other absences. 6) If the tuition due date falls on a holiday or center closing tuition is due the day before the center is closed. 7) Our tuition fee includes a daily morning and afternoon snack. Parents are responsible for providing meals.

Please see meal policy for appropriate meals. 8) In the event that your child(ren) have damaged the property or its’ contents, a fee may be imposed for the

correction of the damage.

I have read, understand and agree to abide by this Fee Agreement and the policies of It’s About Time Children’s Center as outlined in the contract. Parent/Guardian _________________________________________ Date _____________________


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PERMISSION TO USE SUNSCREEN

My child __________________________________, may have SUNSCREEN applied to exposed skin areas when going outside on sunny days. I will provide SUNSCREEN with a sun protection factor (SPF) of 15 or higher (without PABA recommended). PABA gives some children blotchy rashes. I will label my child’s name on his/her SUNSCREEN using a permanent marker.

Signature of Parent/Guardian: _____________________________________________ Date: ___________Signature of Provider: ____________________________________________________ Date: ___________

PERMISSION TO APPLY DIAPER CREAM

My child __________________________________, may have DIAPER CREAM applied to skin areas. I will provide DIAPER CREAM for my child. I will label my child’s name on his/her DIAPER CREAM using a permanent marker.

Signature of Parent/Guardian: _____________________________________________ Date: ___________Signature of Provider: ____________________________________________________ Date: ___________

Transportation Consent

I/we authorize It’s About Time Childrens’ Center to take my child(ren) on excursions in the nearby area within walking distance of the facility and a licensed NYS driver with the supervision of the Provider knowing that health and safety regulations will be in compliance with the Office of Children Family Services (OCFS). I/we will be forewarned before the beginning of the day care opening where my child(ren) will be in a vehicle and will need to provide a car seat for my child as well as proper clothing for the excursion.

Signature of Parent/Guardian: ______________________________________________ Date: ___________Signature of Provider: ____________________________________________________ Date: ___________


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Meals and Supplies Policy

Parents will need to supply the following on a daily basis:

*Please label all of your child’s belongings

1. 1 box of Diapers/wipes and diaper creams (if applicable)2. 2 - sets of extra clothes appropriate clothing for the season3. Breakfast, lunch and dinner4. Breakfast, lunch, dinner and snacks (if there are food allergies or a special diet regimen)5. A toy, stuffed animal, binky that will help soothe the child, 2 sheets and one blanket for rest6. A water bottle with your child’s name on it

Meals will be provided by the following schedule:

Breakfast – 7:45 AMSnack – 9:45 AMLunch – 11:45 PMSnack – 3:30 PMDinner – 6:30 PM

Snacks will consist of a drink (milk, fresh juice, smoothie or water) and a small portion of food (yogurt, cheese, muffin, eggs, pretzels, etc.). We follow the guidelines for NYS healthy food program. Please make us aware of any allergies and we will do our best to accommodate.

Parents are encouraged to follow the “NYS State food guidelines for healthy children” Children ages 2-5 should be served 1% or skim milk, 1 year old children should be served whole milk. It is recommended that children have a rainbow of fruits and vegetables daily as well as a protein and a grain. We recommend that sweet grains or sugary treats be given on a limited basis of one to two times a week. Water drinking is encouraged throughout the day.

Children are not permitted to attend day care with anything that could be considered hazardous to other children such as sharp, heavy or otherwise dangerous objects for young children or materials and media that are age-inappropriate for day care aged children (6 and under). Children are discouraged from bringing toys from home unless it is a special “share and tell” day.

I understand the above policies and agree to all stated by the policies.


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Signature of Parent/Guardian: ______________________________________________ Date: ___________Illness Policy

A child cannot come to the facility and may be sent home if they have a communicable illness which includes:

a. A temperature of 100 F or greater.b. Diarrhea, vomiting, nausea, or otherwise discomfort.c. Coughing, runny nose, discolored mucous.d. Otherwise at the discretion of April Noon to not take the child for the day or call the

parent to pick up the child upon worsening conditions.

Medication cannot be administered by our staff and should not be open and/or otherwise accessible to the child and other children. In the event of a potentially life-threatening emergency, 911 and the parent/caregiver will be called immediately.

My child has the following Food/drug allergies:

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

I understand the above policies and agree to all stated by the policies.

Signature of Parent/Guardian: ______________________________________________ Date: ___________


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Disenrollment Policy

It’s About Time Children’s Centers child care programs are centered on the children for whom we care. We seek to provide programs designed to support children’s growth and to challenge them to learn, each as an individual with a unique learning style and way of responding to the world. Given the diversity of the families and communities that we serve, it is incumbent upon us to recognize and appreciate the characteristics and behaviors that each child and family brings to our program.

It’s About Time Children’s Center seeks a solid partnership with our families as a basis for their children’s success within our program. Because It’s About Time Children’s Center child-centered/family approach seeks to accommodate a wide range of individual differences, it is only on rare occasions that a child’s/family’s behavior may warrant the need to find a more suitable setting for either a short term or permanent basis. We will do everything possible to work with you to avoid a child’s disenrollment from the center. The following are

some reasons why we would have to disenroll a child or family from the center. Some examples of such instances include:

Child’s Actions: • Child unable to adjust to the program after a reasonable amount of time • Ongoing physical or verbal abuse to staff or other children • Ongoing uncontrollable tantrums/angry outbursts • Excessive biting

Parental Actions: • A parent/guardian fails to abide by Center policies or requirements imposed by the appropriate licensing agency. • Non-payment of tuition. • A parent/guardian demands special services that are not provided to other children and cannot reasonably be delivered by the program. This includes requests that depart from the philosophy of It’s About Time Children’s Centers’ program

Immediate Causes for Disenrollment: • A parent/guardian is physically or verbally abusive or intimidating to Center staff, children, or anyone else at the Center. • Potentially dangerous behavior by a parent or child;

Working Towards a Positive Solution The decision to disenroll a child from It’s About Time Children’s Centers Center is a difficult one for both the It’s About Time Children’s Center2 Minto Ct.Centereach, NY 11720(631) [email protected]

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Center and the family. In all cases, It’s About Time Children’s Centers’ goal is to act quickly, thoughtfully and thoroughly to communicate, address and resolve concerns relating to the children in our care. Center personnel will attempt to work with a family to take constructive steps to finding a solution that resolves the problem(s), before a disenrollment occurs.

When a child’s teacher or an administrator has concerns about a child’s behavior or other circumstances, he or she will document such concerns as soon as they arise. The Center will inform and involve the child’s parent/guardian by notes, phone calls, and meetings, as necessary, to establish a collaborative environment.

If the child’s behavior is problematic, a review of that behavior using the Center’s developmental profile and other developmental tools will aid in understanding the behavior in its appropriate context. This review includes input from a number of teachers and administrators, so that checks and balances are used to analyze the problem.

As the Center develops strategies to address a child’s particular problem, a variety of options should be considered, including: • changes to the physical environment • the daily structure of activities • consistency • transition times • redirection

Similarly, teachers’ expectations, home-base management skills, and intervention techniques should be evaluated and changed to adapt to the particular circumstances. Whenever possible and appropriate, efforts will be made to help a family understand how they can support the plan at home or encourage a resolution by adjusting their interactions or expectations for a child. Literature and other support resources regarding methods of improving behavior will be provided to the family, if available. Lines of communication with parents will be established, and parent conferences will be conducted to review the problematic behaviors, the strategies implemented to resolve them (and their relative success) and the possibility of disenrollment if the behaviors are not resolved. It is the Center’s ultimate goal to provide the parents sufficient time to take the necessary corrective action to allow the child to remain at the Center and to provide them with sufficient notice of the potential for disenrollment, so they can secure alternative care.

Ultimately, Center personnel will attempt a number of approaches before making the final decision to suspend or disenroll a child from the program.


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Disenrollment Process

If the behavior has not resolved after all remedial actions have been exhausted, a conference will be held with the child’s parent/guardian to communicate the Center’s decision to disenroll. A follow-up letter will be provided which will include, if applicable: • the reasons for the disenrollment or suspension; • the date of the disenrollment or length of the suspension, which affords the parent sufficient time to seek alternative care, (up to two weeks, depending on safety risks presented); • the expected behavioral changes required in order for the child or parent to return or to resume or continue enrollment at the Center; • the avenue for appealing the decision to disenroll within It’s About Time Children’s Center’s management;

The Center will not disenroll a child based solely on any of the following:

• making a complaint to the Office of Licensing regarding a center’s alleged violations of the licensing requirements • reporting abuse or neglect occurring at the center • questioning the center regarding policies and procedures

If the center elects to disenroll a child, the Center will maintain on file a record of the circumstances, parental notification, and corrective action taken

The Appeal Process

A parent/guardian may appeal the Center’s decision to remove a child from the Center, even when the removal is immediate. The parent/guardian should submit the appeal in writing to the Director, in care of the Center. The appeal must be submitted within ten (10) days of the Center’s notice to the family of the decision to disenroll. The parent/guardian should describe the basis for his/her disagreement with the decision and to provide any supporting documents in this written appeal so his/her position can be fully considered. Upon receipt of the appeal, the Director will review the appeal and will provide a response to the family within thirty (30) days.


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Holiday and School Closing Schedule 2016 – 2017 School Year

Center Closed Friday, July 1st Independence Day Monday, July 4rd Conference Day Monday, July 25th Center Prep for Fall Monday, August 29th – September 2nd Labor Day Monday, September 5th Columbus Day Monday, October 10th Thanksgiving Day Thursday, November 24th Day After Thanksgiving Friday, November 25th In Observance of Christmas Day Monday & Tuesday, December 26th - 27th In Observance of New Year’s Day Monday, January 2nd Martin Luther King Day Monday, January 16th President’s Day Monday, February 20th Spring Recess Monday, April 10th to April 14th Memorial Day Monday, May 29th Center Closed June 23, 2017

NYS OCFS mandates that 15 hours of training each year to be completed by each individual that works in the center in order to maintain licensing. 30 days advanced notice will be given to which days these are.

Please remember… We are open during inclement weather. In extreme conditions, we may need to close the Center or delay opening. If this is necessary you will be notified as soon as possible by phone. Please note, the center will be closed for two weeks of the year.

Holidays and Training Days are billable days, Center closings are not.Our hours are 7AM to 6:30PM Monday to Friday.


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Documents

Parent Interview/ Application Form€¦ · Web view1. It’s About Time Children’s Center. 2 Minto Ct. Centereach, NY 11720 (631) 676-6075. [email protected]