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Daycare Forms

Child In Care Statement

Health Appraisal

Medication Permission

Registration

Child's Name_______________________________________   
Birth Date ______________________
Address_____________________________________________
City ___________________________________ State _____ Zip Code ________
 
Mother's Name____________________________________     
Address __________________________________________
City ______________________State _____ Zip Code______
Home #  ____________________Cell #_________________
Employer______________________Work# _________________
Business Address _________________________________________________________
Work Hours _____________________________________________________________ 
Father's  Name ______________________________________
Address ____________________________________________
City ______________________ State _____ Zip Code_______
Home #  ________________________ Cell #_______________
Employer __________________________Work #____________
Business Address ____________________________________
Work Hours __________________________________________
 
Parent/Guardian with legal custody _____________________________________________________________
Note: copies of legal documents must be provided if one parent is not allowed to have contact with the child.
Primary Emergency Contact  (Within 20 mile radius of daycare other than parent or guardian)
____________________________________________________
Home # ________________________ Work #_______________
Relationship to Child __________________________________
Address ____________________________________________
 
Secondary Emergency Contact (Within 20 mile radius of daycare other than parent or guardian)
________________________________________________________________________
Home# ________________________ Work #________________
Relationship to Child __________________________________
Address _____________________________________________
 
Person(s) authorized to pick up my child: (Besides parents, guardians, or emergency pick ups)
_______________________________________________________________
_______________________________________________________________
Person (s) NOT authorized to pick up my child: (Besides parents, guardians, or emergency pick ups)

Emergency Information
1. Physician ___________________________________ Phone____________________
2. Hospital: ___________________________________ Phone____________________
3. Insurance ___________________________ Policy#_________________________
4. Regular Medications_____________________________________________________
5. Blood Type ____________________________________
6. Medicine allergic to _____________________________________________________
7. Food Allergies _________________________________________________________
8. Any other Allergies _____________________________________________________
9. Any special health conditions _____________________________________________________
 
Disclaimer

Free To be Me Childcare / Loreine Wynne, shall not be responsible for providing or paying for the child's health care. I agree that neither I or my child will bring any claims of any kind against Loreine Wynne / Free To Be Me Childcare  as a result of any injuries, expenses or damages that I or my child may suffer in any way related to the use of our facilities, toys, other children, teachers, whether such claims are known or unknown or arise in the future.
 
Consent to Emergency First Aid &Transportation
 
I hereby give permission to Free To Be Me Childcare / Loreine Wynne  to provide emergency treatment  to my child, as needed.  I also give permission for my child to be transported by car, ambulance, or aid car to an emergency center for treatment. I hereby expressly waive any claim for injury or damage to such child arising out of such care, treatment & transportation, and expressly agree to hold Free To Be Me Childcare / Loreine Wynne harmless.

Field Trip Permission
 
I hereby give permission to Free To Be Me Childcare/Loreine Wynne  to allow my child to participate in field trips, go to the park, or any other activities that would involve taking the child outside of the daycare for his/her benefit in attendance at this facility.
I hereby expressly waive any claim for injury or damage to such child arising out of such field trip and expressly agree to hold Free To Be Me Childcare / Loreine Wynne  harmless.
 
Lotion & Bug Repellant Permission
 
I hereby give permission to Free To Be Me Childcare / Loreine Wynne  to apply sun block lotion and/or bug repellant spray or lotion to my child as needed. I hereby expressly waive any claim for injury or damage to such child arising out of such application and expressly agree to hold Free To Be Me Childcare harmless.
Parent's Signature________________________Date _________________
 
 

 

Free To Be Me Childcare

Contract

The following agreement is made between Parent(s)/ Guardians and Provider of

Child‘s name:______________________Birthdate:_____________ for childcare services.

Parent/Guardian name:____________________________________________________

Address:________________________________________________________________

Provider’s name___________________________________________________________

Address:_________________________________________________________________

The Terms of the agreement are as follows:

Effective date:_______________________

Hours my child will attend are from: _________to___________ On M T W TH FRI .

(circle all that apply)

Fees:____________ per Week.

 

We Understand and agree to abide by the policies, and terms of this agreement.

Parent/Guardian signature:__________________________________________Date: ____________

Parent/Guardian signature:__________________________________________Date: ____________

Provider signature:________________________________________________Date:_____________

Comments:

 

 

 

*Due to the limited spaces available, weekly payments are based on using or holding your slot, not on the child's attendance. No refunds are given for late arrivals/early departures, parental vacations or exclusion due to illness. The exception is the one unpaid week that I take off the first week of July.

*FIA Payments and Parent Payments

If a child receives state assistance with their tuition, the parent is responsible for any fees not covered by FIA. They must also adhere to the same payment and childcare polices as private pay individuals. The parents are responsible for payments until the state begins paying the child care costs. Parents are responsible for any part of the tuition not covered by FIA.

Free To Be Me Childcare

Parent Handbook 2010

Hours: 6:30am-5:30pm

Monday-Friday



Welcome:

The purpose of this handbook is to inform each parent what to expect from my childcare and what I expect from each parent. If after reading it you still have questions, please feel free to ask so that I may clarify anything you might not  understand. Please make sure you take the time to read through the entire handbook, as you will be given a form to sign at the time of enrollment, which states that you have received the handbook and understand all my policies and will abide by them. 


My Philosophy: 

I believe that play is the best means of learning in young children. While playing with blocks children are learning pre math skills. When looking and listening to stories children are learning pre reading and speech skills. Puppets and playing house teach children socialization skills. Playing in dirt, flower beds or the sand teaches children pre science skills. So when you see your child playing, don’t look at it as playing instead look at what they are learning while they are playing.


Mission: 

I will provide your child a safe, smoke free , and loving environment. I want to help children grow physically, emotionally and socially, at their own pace. Since there is a broad range of behaviors exhibited by children. What works for some may  not  for  others. I will tailor my approach to accommodate the needs of the individual child, is where the name “Free To  Be  Me “ comes into play. 


My Goals:  

To make each child’s daycare experience a positive, happy one. To stimulate each child’s thinking and reasoning skills. To help each child learn to solve problems and make decisions and choices that  are morally appropriate. To help each child recognize the rights, feelings and property of others. To encourage sharing and cooperation. To promote a sense of belonging and cooperation. To help prepare preschool age children for a successful transition to Kindergarten.


Communication:  

Communication is very important between a care giver and a parent. We need to be able to talk openly with each other about any concerns, questions or ideas that might help in your child’s growth and development. If sensitive issue’s need to be discussed and you want to do so in private. Please let me know so we can either step away or do it at a different time. Also we may discuss things after childcare hours either by phone or appointment .  But due to my longer hours of care and my free time being very valuable. Appointments should be made for serious matters only. My family time is very precious to me and I feel business matters should be handled during business hours. Phone calls need to be kept to important issues. If you call during childcare hours please be aware that I may be busy and unable to answer the phone or talk for very long. You may leave a message and I will get back to you as soon as I am able . I will give each parent my email address of which I will check every morning and nap time if you have any questions or concerns please feel free to email me. Any children in care at the time of your call will be my top priority. The best time to call is after childcare hours if you need to talk for more then a few minutes. 

I am  Adult/Infant/Child CPR/AED, First Aide certified. I have had FBI fingerprints taken, and my husband and I have had background check’s and medical release’s to ensure your children are in good care. I must be certified yearly in  Adult/infant/child ,CPR/First aid certification every 3 yrs. 


Holidays closed:

The following days I will be closed for the Holiday’s. These are Paid Holidays. Memorial Day, July 4th, Thanksgiving and the day after and the week between Christmas and New Years  Day  we will be closed.  (*These may be subject to change. )


Child/Provider Vacation Policy:  

If possible I  request a 2 week notice of any vacation time you will be taking..   At these time you will still be responsible  for Tuition. I will take one week of unpaid vacation a year of which  will  be the first week of July. Depending on what day of the week the 4th lands on.   


Night care:  

On occasion I will do night or weekend care if I am available and it is planned in advanced. 


Enrollment:

Each child will be enrolled on a two week trial period. If at any time during those two weeks the provider or the parent feels that things are not working out for the benefit of all the children, care can be terminated without giving notice. All monies due for the time the child was in care must be paid and no additional charges will be charged. If monies are not paid a $10 per day late fee will be applied until all monies are paid. There are several forms that I must have completed and in my possession before I can assume the responsibility of caring for your child. 

NO EXCEPTIONS WILL BE MADE! 

This is to ensure that your child will get the very best care possible from me. 

The forms are as follows: Registration  form both pages, must be filled out completely  ,Child in Care Statement, Immunization Record completed, signed (copy), Signed Contract and Rate Agreement, Medication Permission Slip (whenever med’s must be given during childcare hours), Child Enrollment Records, Policies agreement form  signed and dated. 

*These records become the property of Free To Be Me Childcare and are not available to you when your child leaves. According to licensing regulations I have to keep these records in my files for seven years.


Tuition Payment Policy

Part-time : will be a set weekly fee based on the hours your child attends. Up to 25 Hrs a week.  If a full-time opportunity  becomes available, I will give you the option to pay full rate to hold your spot. Otherwise you may  be bumped.  Due to my limits on Children Full-time spots are very valuable. The only alternative is if I have another child who is part time and the hours work together to take only one full-time spot.  With the increasing cost of living I have no choice but to do it this way.  Instead of continually increasing my rates. 


Full-time : 30-50 hrs : Infants - 12 yrs. $185.00 a week 

 

**Anything over 50 hrs will result in a additional hourly rate of $5.00 a hr. 


Drop off care : $5.00 a hour, Only  if spots are available.  


Part-time care: $50 a day.


Before and after school care: max of 4 hrs a day at $80.00 a week.


Payment is expected even if your child does not attend. This is to hold your spot. I do not discount for days off or sickness. 


Contracted Hours

Prior arrangements (12 hour minimum notice) must be made and additional fee agreed upon in advance for early drop offs and late pick ups. I plan the childcare schedule, my own personal schedule and the schedule of new enrollees around the contracted schedule. So I need advanced notice to see if I can accommodate your request for additional care. Hours need to be specific and everyone needs to be prompt and on time. Do to different schedules I take on kids that will fit my schedule. So being late might and at times put me out of compliance. So it is imperative that you are on time and at the same time every day. The children depend on it as well. Thank you!!! 


Late Payment Fees:

Payment is due by 5:30 p.m. every Friday. If payment is not received 5:30 p.m. Friday a $10 per day late fee will be applied for each day the payment is late. If your account becomes more than one week delinquent childcare will be suspended until your account is brought current. If your child will be absent on Friday you will still be responsible for payment by 5:30 pm. on that day.  If your child is enrolled in part time care payment will be due on the last day the child is in care for the week. If payment is not received by the end of that day a $10 per day late charge will be applied for each day the payment is late. 


*Any payment made after 5:30 p.m. on their due date will be considered late as I close at 5:30 p.m.


NSF fee for Returned Checks:

Payments may be made by check, money order or correct cash payment. If at any time a check is returned to me for Non Sufficient Funds, there will be a $25.00 fee in addition to the tuition amount the check was written for. Childcare services will be halted until the full payment of the tuition and the NSF charges has been paid in cash or certified funds. In addition, I will only accept cash or money orders from that point on.


Withdrawal Policy: 

If you decide to withdrawal you child from care a two week written notice must be given .   You are responsible for the you’re your child attended and the 2 weeks as well. If no notice is given and you withdraw immediately, payment for the 2 weeks and the week they attended is required immediately.  A $20 a day late fee will apply every day until payment is made.   If written notice is given and the  child is to remain for the 2 weeks,  payment then is expected on or  before your child’s last day. Withdrawal notice will not be accepted while the provider or parents are on vacation.  


Absences: 

Please call whenever your child will be absent. It lets us know that we can go ahead and start our day instead of holding off for a bit to see if your child is coming.  If possible preferably the night before.  


Additional Days: 


If you should discover that you need additional hours or care during the week, you may request that time. I will try to accommodate any request for additional time provided that I have open space on the day desired. Payment for the additional time will be calculated and added to your account and will be payable on that weeks tuition payment.


Releasing Child for Pickup: 

Children will only be released to their parents or someone designated. Only persons listed on the child’s information record will be allowed to pick up the child. Children will not be released to anyone under the age of 18. Children will not be released to anyone I suspect of drinking or otherwise impaired. All persons picking up children must have a picture ID before releasing the child into their care. 


*These rules were put into effect to ensure the safety of your child. There will be NO EXCEPTIONS made!!! 


Child Custody/Court Order: 

I have no legal authority to refuse either parent the right to pick up their child unless a court has granted temporary or permanent custody to one parent or to a third party. I must have a copy of the court order bearing the court’s signature. If you have a restraining order against the other parent or another person I must also have a copy of it. Please help me protect your child by complying with this request. 


Change of Address and Other Information: 

It is the parent’s responsibility to keep all addresses, phone numbers, and work information current and up to date. Please put any changes in writing and give them to me personally. I need to be able to reach you at all times in case of a sudden illness or accident.


Sick Child Policy: 

In order to provide the best possible care, and to minimize the risk of spreading infection and illness. Parents are asked not to bring a child if he/she is vomiting , or has any contagious illness, severe cold, or diarrhea. Children not well enough to go outside , or participate in activities, should not be at daycare. Parents must notify me if the illness is contagious (ex. Pink eye, strep throat, etc.) If you are not sure about bring your child. Please feel free to contact me and we can then discuss if I will be able to care for them. With this in mind, any policies regarding sick children need to be considered extremely important.


When Your Child Becomes Sick at Childcare: 

Unfortunately there will be times when I must call a parent to come and pick up their child due to illness. Please arrange to have your child picked up with in an hour if possible. If your child is to ill too go outside then they are to ill to be in childcare. 


Administering medication to your child: 

The administering of medication is very serious responsibility for me to take. There are rules and regulations that I must follow in order to ensure your child’s safety. I can only give medications and apply special procedures, or give dietary supplements with prior written permission from the parent. This includes diaper rash creams and sunscreen. Read and fill out the Medication Permission form and sign and date it. Bring medication directly to me and in its original container with the prescription and/or directions on the container. It is not to be left in diaper bags or backpacks. Be sure the prescription container has your child’s name, the name of the medication, directions for administering, the dosage, the name of doctor, the phone number of the pharmacy that filled it and the date it was filled all clearly visible on the container. First dosage of medication must be given at home. Due to the possibility of adverse reaction, no first dosage of medications will be given at childcare. Please wait several hours after the first dosage to observe your child for any adverse reactions before bringing your child to care. If you have more than one child on the same medication each must have their own prescription container clearly labeled with their name, dosage, directions for administering, doctor’s name, pharmacy’s name and phone number clearly visible on the container. I will not give one child’s medication to another so please don’t bother asking me to. Any medications that only need to be given twice a day must be given at home. Please let your doctor know that your child is in childcare. Most often medications can be administered before the child is brought to care in the morning and again in the evening when they get home, avoiding administering of medications at the childcare. 


Emergency /First Aid Policy: 

If the child is injured in a non life threatening way, I will assess the child and provide home first aid. If the injury is more serious, the parent will be notified so the child can be transported to the hospital or doctors office. (I.E. need stitches, broken arm, etc) In case of a medical  emergency.  I will attempt to contact you immediately. If I am unable to reach you. I will start calling the designated as your emergency contact. If I am unable to reach you or your emergency contact, I will transport your child to his/her doctor or to the hospital. If necessary immediate intervention is required I will take appropriate action including calling 911 and having your child transported to the nearest hospital or one you have specified, whichever is in the best interest of the child. You or your families insurance is responsible for the cost of medical help or treatment due to accidents or illness while in childcare.


Inclement Weather: 

During inclement weather all children will be kept indoors. Children will not be taken out in the winter when the wind chill or temps go below 20 degrees. In the summer they will be only be taken outside in the morning when the temps or heat index is to go above 95 degrees that day or on ozone action days. In the event of a tornado children will remain in the basement. In the event of a power failure if after a couple of hours the power does not come back on parents will be called to pick up the children. I am not allowed by licensing to remain open more than 2 hours without power or heat.


House Rules: 

There is certain house rules put in place for the safety of all children in care. Children will try to test these rules when you come in. Please help me to enforce these rules whenever you are present. No hitting, pushing, No standing, climbing or sitting on tables or shelves. No standing in chairs. NO JUMPING over other children allowed. A 3 year old could do serious injury to a baby or toddler if they tried to jump over them and landed on them instead. No obscene, derogatory or disrespectful language allowed. Shoes need to come off at the door no exceptions, this helps keep the floors free from dirt for the younger children.  Children are not allowed to go outside without an adult, so please do not send your child to the car or allow them to run outside while you remain in the house. Children will respect me, my family, my home, my property and other children’s property. Please have your child leave their toys at home. I have more then enough for them to play with and it is much easier on everyone when our home toys don’t come to childcare. It can result in conflicts and then the child needing to put it in their cubby till they leave.  Unless it is a special nap item or item of security.


Birthdays : 

Each child’s birthday is his/her special day. We will celebrate it by singing Happy Birthday . If you would like to bring a birthday treat for the day, just let me know in advance. Due to some children may have allergies I would have to ok it first. 


Nap time: 

All children 5 years old and younger will be required to have a nap/rest time. Children who can do a quite activity/Movie may do so. But if they are unable to do so, then they will be required to take a nap.



Open door policy: 

Parent’s are always welcome to drop in and see your child at any time during regular hours. The front door may be locked for the safety of the children and to prevent unwanted visitors from entering.  If I am not free to speak with you when you come to visit, please understand that the children come first during times of operation. Also that you understand that we need to adhere to our schedule for everything to run smoothly. The one that would be very disruptive to our day is nap time. The children need their rest and quiet time to refresh. But if you want to peek in on them and see how they are doing that is fine. That is the only time of the day I get a break and so I value the opportunity to get things done and some down time of my own. 

Discipline (Positive behavior Supports):

Active and happy children are the signs of a good childcare. The following methods are utilized. Rules are first explained with plenty of positive reminders. Acceptable behavior is encouraged by giving positive verbal rewards. This reinforces a child’s good feeling about his/her behavior and serves as an example to the children to act in such a way as to receive this praise. Asking a child to stop and think about their behavior enables the child to work at self control


 12 months to 3 yrs:

redirection of the child’s behavior, explain the problem or the inappropriate actions of the child and redirect the child. 


3 yrs and up

I will first intervene with conflict resolution in helping the child find a solution to the behavior and how they are feeling.  If this is not  working then a 123 with a warning/redirect/then the thinking chair, depending on the age and severity of incident. The thinking chair is not a punishment, but rather a time when the child may calm down, remember  what behavior is acceptable, Thinking time consisting of 1 min per year no more then 5 minutes. When thinking time  is up, I will talk to the child and explain why that behavior was inappropriate. In any instance where the child’s behavior is continually upsetting  and if of concern to me. I will need to discuss it with you. So that we may jointly decide on a course of action that if followed at home and in my care. If the problem cannot be resolved, arrangements may need to be made for the child to receive care elsewhere. A child will never be disciplined for accidents.


Meals and Snacks: 

I will provide *one main meal and 2 snacks to children ages 18 months and up.  Parent’s of infants are to provide formula, infant juice, infant cereal, baby food (at appropriate ages).

I am required to feed your child nutritious and healthy foods. If your child is on a special diet I may request that you provide their meals. 

* If a additional meal is needed. That will be discussed at time of enrollment. 


Infants and Toddlers: 

It is your responsibility to supply diapers, pull ups, training pants, rubber pants (training pants), bottles, pacifiers, teething rings, diaper rash cream, and extra clothing. Toddlers will not be allowed to walk around with sippy cups, pacifiers or bottles. A sippy cup will be introduced at meals and snack time at the age of one or before depending on the child.  Children learn as young as 1 yr. to leave their cups at the table. 


Toilet Training:  

Is pretty much based on the individual child and when they will be ready. The goal is to be trained by 3-31/2 yrs. I do ask that we have consistency between home and childcare in order for them to have success. At this time please refrain from dressing your child in pants, shorts with buttons and zippers. Elastic waist items work best for them to pull up and down. Please make sure to have enough extra clothing here in case of accidents. I have found over the years that no one way works for all of the children. 


Learning Activities:

From the first week of Sept through the last week of May a daily schedule Monday - Friday. Learning sessions will be held from 9:00 am-10:00 a.m. with short breaks in between. While they are aimed for ages 2 ½ thru 5 years of age any child no matter what age may participate if they want to. I have in my Theme’s Section on this site, what we will be working on for each month, along with other resources for information. We work on basic skills such as ABC’s Numbers, Colors and Shapes. Learning with songs, signing  etc. The age and ability of your child will determine how much he/she learns. These Activities may change during breaks and snow days. During the summer months we will just reinforce what we learned throughout the year. 


Indoor Play: 

I provide a variety of age appropriate toys and activities. There are puzzles, books, jungle gym, play dough, free art, music time, story time, blocks, fine and gross motor play, many ride on toys, plus more. The children are free to play and express themselves in each area.


Outdoor Play: 

During warm weather we spend a lot of time outdoors. During the summer there are many things we do like soccer for all ages, Basketball, Hockey, Tennis, Football,  sidewalk chalk and sprinkler for all the children. Sand & Water play  and blocks, with outdoor ride toys. Etc.  

*Please make sure your child is dressed appropriately for the weather of the day. Otherwise it may limit us to what we can do. 


Revisions to Handbook and Rate Agreement Contract:

There will be a yearly revision to this handbook and the accompanying contract. All families will sign a new contract each year. I reserve the right to make changes in the rates and policies, as I deem necessary. You will be notified in writing, of any changes that may occur. I will provide you with at least a month in advance notice of any changes. 


Daily Schedule : 

6:30 am: Arrivals- children have free play , morning Preschool Programs for ages 2 1/2 and up, Diaper check. 

8:45 am: Circle time (stories sharing, favorite songs, Learning shaped, colors and letters. Learning some signs), Infant nap time. 

9:00 am: Clean up, Hand washing, snack 

9:30 am: Learning Activities, Crafts, choice of table activities., *If your child arrives, after 9:30 am, please feed them prior to arriving. 

10:00 am: Inside or outside (weather permitting) free play. (varies depending on the age of the children)

10:45 am: hand washing, Children’s video or educational TV, such as Noggin or PBS ( while I prepare lunch)

11:30 am: lunch, If your child arrives after 12:00 pm, please feed them prior to arriving. 

12:10 pm: Clean up, bathroom, hand washing., 

12:30 pm: Story time/or movie, floor time 

1:00 pm: Nap/Quiet time (Movie or books for older children)

3:00 pm: Wake up, bathroom, diaper changing, hand washing, Snack time. 

3:30 pm: Free play, choice of table activities, outdoors. 

5:30 pm: Free To Be Me Childcare closes  

  

*This schedule is subject to change depending on the children’s needs for the day. I usually do diaper changing about 20 min after snacks and meals and right before and after naptime. With infants I check them every  1 -2 hrs and after feedings, and naps.