SUMMER CAMP ENROLLMENT FORM It is my understanding that summer camp is a 10-week program as follows. Indicated below are the weeks that my child will be attending summer camp. I agree to pay the full week’s tuition of $140.00 each week my child will be attending. I agree to have my child here on time for the scheduled field trips and understand that if I do not, monies are still owed and other arrangements in our program will be made for child care that day. Schedules and Field Trip permission forms are located at the Front Desk and parents understand that it is their responsibility to have their child signed up on the Field Trip Permission forms for the child to participate. All other contractual terms and conditions are attached and incorporated here in. A parent orientation is scheduled for Thursday, May 18 th at 5:30PM and it is recommended that all parents/guardians attend. Please place a check mark next to the weeks your child will be attending Dacula Academy’s SUMMER CAMP. By placing a check mark, you are stating that you agree to being invoiced and paying $140.00 for that week of summer camp. I UNDERSTAND THAT THE CENTER WILL BE CLOSED ON MEMORIAL DAY (MAY 29 TH ) AND INDEPENDENCE DAY (JULY 4 TH ) WEEK ONE May 29 th WEEK TWO June 5 th WEEK THREE June 12 th WEEK FOUR June 19 th WEEK FIVE June 26 th
Transcript
SUMMER CAMP ENROLLMENT FORM
It is my understanding that summer camp is a 10-week program as follows. Indicated below are the weeks that my child will be attending summer camp. I agree to pay the full week’s tuition of $140.00 each week my child will be attending.
I agree to have my child here on time for the scheduled field trips and understand that if I do not, monies are still owed and other arrangements in our program will be made for child care that day.
Schedules and Field Trip permission forms are located at the Front Desk and parents understand that it is their responsibility to have their child signed up on the Field Trip Permission forms for the child to participate. All other contractual terms and conditions are attached and incorporated here in.
A parent orientation is scheduled for Thursday, May 18th at 5:30PM and it is recommended that all parents/guardians attend.
Please place a check mark next to the weeks your child will be attending Dacula Academy’s SUMMER CAMP. By placing a check mark, you are stating that you agree to being invoiced and paying $140.00 for that week of summer camp.
I UNDERSTAND THAT THE CENTER WILL BE CLOSED ON MEMORIAL DAY (MAY 29 TH ) AND INDEPENDENCE DAY (JULY 4 TH )
WEEK ONE
May 29th thru June 2, 2017
WEEK TWO
June 5th thru June 9th, 2017
WEEK THREE
June 12th thru June 16th, 2017
WEEK FOUR
June 19th thru June 23rd, 2017
WEEK FIVE
June 26th thru June 30th, 2017
WEEK Six
July 3rd thru July 7th, 2017
WEEK SEVEN
July 10th thru July 14th ,2017
WEEK EIGHT
July 17th thru July 21st, 2017
WEEK NINE
July 24th thru July 28th, 2017
WEEK TEN
July 31st thru August 4th, 2017
Initial the weeks that your child will attend
***Payments will be invoiced on Friday (IE... June 2nd) and processed the following Monday (IE…. June 5th). All Declined debit/credit cards will incur a $55 charge per instance ($35 processing fee & a $20 late charge) ***
2303 Alcovy Rd. Dacula, GA 30019 HOURS 770-962-4128 OFFICE 6:00 AM until 6:30
PM 770-962-4158 FAXwww.daculaacademy.com
PRICE LIST REGISTRATION FEES $60.00 PER CHILD/ANNUALLY
$100.00 PER FAMILY/ANNUALLY
WEEKLY RATES: Tuition Express Enrolled
INFANT (6 WEEKS TO 12 MONTHSOR 18 MONTHS IF NOT WALKING) $180.00 $175.00TODDLERS $170.00 $165.002 YEAR OLDS $160.00 $155.00
3 YEAR OLDS $160.00 $155.00
4 YEAR OLDS $160.00 $155.00
*GA PRE-K CHILDREN ARE CONSIDERED SCHOOL AGE AND ALL RATES ARE APPLICABLE.
*PART TIME BEFORE/AFTER SCHOOL RATES ARE FOR PRE-ESTABLISHED DAYS DURING THE WEEK.GA PRE-K LUNCHES No Fee
Any Families NOT enrolled in the Tuition Express Payment Plan will be charged $5.00 more per week per child for a payment processing fee.
No T/E Enrolled in tuition ExpressBEFORE & AFTER SCHOOL $ 85.00 $25.00/day(currently enrolled)BEFORE SCHOOL ONLY $ 65.00 $15.00/day(currently enrolled)AFTER SCHOOL ONLY $ 80.00 $20.00/day(currently enrolled)SUMMER CAMP PROGRAM $145.00 $140.00/week EARLY RELEASE $10.00/day will be charged to before and
after school age accountsTEACHER WORK DAY $20.00/day will be charged to before and
after school age accounts10% DISCOUNT
FOR FAMILIES WITH TWO OR MORE CHILDREN5% DISCOUNT FOR FAMILIES WHO PAY QUARTERLY OR
MONTHLY IN ADVANCE
VEHICLE EMERGENCY MEDICAL INFORMATION
Child’s Name Date of Birth
Address
Father’s Name
Home Phone Work Phone Cell Phone
Mother’s Name
Home Phone Work Phone Cell Phone
Person(s) to notify in an emergency if parents cannot be reached:Name: Telephone:Name: Telephone:Name: Telephone:
Child’s Doctor Telephone
Medical facility the center usesGWINNETT MEDICAL CENTERAddress1000 MEDICAL CENTER BLVD., LAWRENCEVILLE, GA 30045 (678) 442-4321
1) Does your child have any allergies? _______ Yes _______ No
If yes, explain:____________________________________________________________
2) Does your child currently take any medication? _______ Yes _______ No
If yes, explain:_____________________________________________________________
3) Does your child have any special medical needs and/or conditions? ______ Yes _______No
If yes, explain:______________________________________________________________
In the event of an emergency involving my child, and if Dacula Academy cannot get in touch with me, I hereby authorize any needed emergency medical care. I further agree to be fully responsible for all medical expenses incurred during the treatment of my child.
Home Telephone Dad e-mail address Mom e-mail address
Father’s Name Social Security Number Birth Date Home Telephone
Dacula Academy accepts all applicants for enrollment and does not discriminate with regards to race, sex, age, religion, color, national origin or physical or mental
handicap. All applicants must meet qualifying standards before child/children may attend.
Please list the names, addresses and telephone numbers of child care facilities or persons responsible for the care of your child/children for the past three years
Name Address Telephone Number Dates of Enrollment
Name Address Telephone Number Dates of Enrollment
Name Address Telephone Number Dates of Enrollment
I understand by execution of this document that income will be verified and references will be checked before my child will be able to attend Dacula Academy. I have been made aware that a $60.00/child or $100.00/family registration fee is due at the time of application and is non-refundable unless the applicant cancels the agreement in writing within 72 business hours.
Once your application has been processed and approved an enrollment package will be issued for completion and an orientation session scheduled.
I certify that answers given herein are true and complete to the best of my knowledge. In the event of my child/children’s enrollment, I understand that false, incomplete or misleading information in my application or interview(s) may result in dis-enrollment.
Street Address:________________________________ City:__________________ State:______ Zip:____________
Phone No. ___________________ Are we able to contact in case of an emergency? _______Yes ________ No
Medical Information
Child’s Physician or Clinic Name_______________________________________________
Street Address: ___________________________ City:_________________ State: _______ Zip: __________
Phone No. _______________________
1) Does your child require any special accommodation(s) to most effectively meet his or her needs at Dacula Academy? _______ Yes _______ No
If yes,explain:__________________________________________________________
2) Does your child have any allergies? _______ Yes _______ No
If yes,explain:__________________________________________________________
3) Does your child currently take any medication? _______ Yes _______ No
If yes,explain:__________________________________________________________
4) Does your child have any special medical needs and/or conditions? ______ Yes ______No
If yes, explain:__________________________________________________________
Parent/Guardian Signature ________________________________________ Date _____________
Director/Assistant Director ________________________________________Date ______________
Parents: We are in need of updated enrollment information on all of our current customers. We understand that we already have this information on file but per state guidelines, we are
required to get all information updated. If you would please take a moment to fill this out in its entirety, we would greatly appreciate it.
Dacula Academy accepts all applicants for enrollment and does not discriminate with regards to race, sex, age, religion, color, national origin or physical or mental handicap. All applicants must meet qualifying standards before child/children may attend.
Place of Employment Occupation/Title Annual Income
Business Telephone Number Pager Number Cell Phone Number
EMERGENCY MEDICAL AUTHORIZATION
Should _____________________(child’s name),________________(date of birth) suffer an injury or illness while in the care of Dacula Academy and the facility is unable to contact me (us) immediately, it shall be authorized to secure such medical attention and care for my child as may be necessary. I (We) agree to keep the facility informed of changes in telephone numbers, emergency contacts, etc. where I can be reached.
The facility agrees to keep me informed of any incidents requiring professional medical attention involving my child.
1) Does your child have any allergies? _______ Yes _______ No
If yes, explain:____________________________________________________________
2) Does your child currently take any medication? _______ Yes _______ No
If yes, explain:_____________________________________________________________
3) Does your child have any special medical needs and/or conditions? _______ Yes _______ No
If yes, explain:______________________________________________________________
Signed_________________________ Date___________ Telephone Number:_______________________ Parent or Legal Guardian
DACULA ACADEMYCHILD’S NAME: __________________________________This form must be completed and signed by your child’s doctor or clinic and returned to Dacula Academy of Preschool and Child Care, Inc. within 30 days of enrollment. Immunizations:
Are the child’s immunizations up to date? ________________ please proved the child’s immunization records on form 3231 to Dacula Academy of Preschool and Child Care, Inc.
General physical condition:At present time _____________________________ During past year
1. Is the child subject to frequent?Colds_____________ Diarrhea ___________ Earache ______________Sore Throats _______ Vomiting ___________ Other ________________
2. What operations has the child had? _____________________ When? __________
3. Significant illnesses, congenital defects, family history: ________________________________________________________________________________________
4. Significant factors in family situation: _______________________________________________________________________________________________________Please check items below where abnormalities are known or found and describe
in space below:____ Skin ___ Nose & Throat ___ Heart ___ Hernia ___Genito-urinary____ Eyes ___ Mouth ___ Lungs ___ Posture ___Nutritional Status____ Ears ___ Glands ___ Abdomen ___ Extremities ___Scoliosis
Description:
Treatment Advised:
Specify medical recommendations to school for academic and activity program. (Please use other side if necessary)
The above child has been examined and found to be in satisfactory physical condition (or any known special condition is under treatment) and may be admitted to Dacula Academy of Preschool and Child Care, Inc. without endangering the health of the group or this child. The above is true to the best of my knowledge.
Physician or Qualified Health Care Provider’s Signature ___________________________Date_________
Address ______________________________________________ Phone Number ___________________
General InformationDacula Academy serves children age six (6) weeks to thirteen (13) years of age. Out hours are 6:00AM till 6:30PM, Monday through Friday.
ENROLLMENTWe are a teaching facility and are looking to partnership with parents seeking a professional child care and development program. We do not take children on a part time basis nor drop in service. By execution of this contract we expect your child to be here each week they are enrolled. Weekly tuition is charged unless you have complied with our illness and vacation procedures.
Enrollment Package: All enrollment forms must be completed and on file before any child is admitted to Dacula Academy your child’s immunizations (form 3231) must be received within 30 days of your child’s start date and all shots must be up to date. We also require a current medical questionnaire to be completed by your pediatrician. Please include a copy of your child’s birth certificate and social security card with the completed application. The enrollment forms are kept confidential and only available to administrators, teachers, parents (legal guardians) and Bright from the Start Licensing agency and the local health department.
Registration Fees: Dacula Academy requires annual registration fee of $60.00 per child or $100.00 per family. The registration fee is due with the application upon enrollment. The registration fee and enrollment package is renewed on September 1, every year. The registration fee is non-refundable.
Parents are responsible for updating their child’s records. All files must have current phone numbers, work location, emergency contacts, child’s doctor etc. A form will be provided at the front desk to make any changes necessary.
Arrival and Departure: All children must be escorted to and from the building by the parent, person authorized by parent, or facility personnel. We encourage all families
to visit the classrooms and visit with the staff as well as observe the environment their children are growing in. All children must be signed in at the front desk and then escorted to their appropriate rooms. All children must be signed out at the front desk at the end of the day. If someone else will be picking your child up, please see someone at the front desk. Your child will not be released without proper paperwork.
CONTROLLED ACCESS SYSTEM:VISITORSAll visitors will be required to identify with a photo identification of themselves and their purpose before entering the building. They will be required to use the doorbell located at the upper right of the door and sign in and out at the front desk.
PROCEDURES This system does not work if you hold the door open for those
you do not know. Please make sure you allow the door to close behind you.
Only the legal guardians of the children and authorized persons to pick up will be assigned entrance codes. Those family members that are dropping off your child or picking up your child must be registered in the finger print scanner.
Every child is to be check in at the front desk using the finger print scanner.
Please make note that this system will track the exact time you drop off or pick up your child. This tool will be used to assist us with late pick up fees and the correct time of pick up.
CURRICULUM AND DAILY SCHEDULESWe use The Creative Curriculum for Early Childhood. The Creative Curriculum is rooted in educational philosophy and theory as well as practice. It builds on Erik Erikson’s stages of socio-emotional development, Jean Piaget’s theories of how children think and learn, on principles of physical development, and an appreciation of cultural influences.
Daily schedules and lesson plans are posted in each classroom. They are in the Parent Information Boards and the front desk. We believe that children learn through play and we will need your assistance and support by bringing the following items for your children:
Complete Extra Change of Clothes including socks and shoes.
Paint shirt-an old shirt from Mom or Dad is good.
Sun screen, insect repellent, etc.
Tooth Brush and Tooth Paste
Please note we go outside every day, children need to dress accordingly. Also, we often have messy activities and clothes will get dirty. Parents are encouraged to bring extra outdoor clothing such as hats, mittens, coats, etc. Your child will go outside unless we have a written doctor’s statement explaining why they are not to go outside and the specified dates.
INCLEMENT WEATHER CLOSINGIt is our policy to follow Gwinnett County Board of Education’s Guidelines on school closings due to inclement weather. When Gwinnett County Schools are closed for holidays please proceed with the following:
Check your local TV news stations and check our answering machine. We will contact the news stations and leave a message with instructions on the answering machine no later than 5:30 am. The decision to close or delay opening will be based on the Georgia Department of Transportation’s advice on the streets in the areas surrounding the school. Prices will not be adjusted due to weather that is beyond anyone’s control.
TUITION
Tuition rules are as follows:1. If your child attends one (1) to five (5) days, full tuition is due. 2. If your child is absent for an entire week due to their illness (you must have
a doctor’s statement to receive ½ price tuition for this week) or one week of tuition is due.
3. Tuition is due on Friday for the upcoming week.4. If your tuition is not paid by Monday, a late fee of $20.00 (per child) will be
added. 5. If your tuition is not paid by Tuesday, we will not be able to keep your child
and your space will be awarded to another family on the waiting list without notice to you.
6. There is a $35.00 fee for returned checks. Payment will not be accepted by check after the second NSF Check only in cash, money order or cashier’s check.
7. We close at 6:30PM. If you are late a $15.00 late fee will be charged for the first five minutes. If you are more than five minutes late, a late fee of $1.00 per minute will be charged. These fees are per child and due with your next week’s tuition.
8. I agree to pay the weekly rate of $___________ Initial _______ Initial ______ (Both Parents/Guardians Initials)
9. We accept cash, checks, money order, debit cards, MasterCard and Visa
VACATIONOne free week after One year of enrollment will be credited to your account with a
two weeks’ notice in writing of when you plan to take your vacation. We must receive a two weeks’ notice in writing before vacation (1/2 price will be awarded).
HOLIDAYDacula Academy will be closed on the following Holidays:
1. New Year’s Eve and Day2. Memorial Day3. Independence Day4. Labor Day5. Thanksgiving Day and the following day6. Christmas Eve and Christmas Day
****Remember if your child attends on or five days, full tuition is due.
GRIEVANCE PROCEDURES AND TERMINATING CHILD CAREIf you become unhappy with our program or see that for other reasons you need to terminate your childcare we ask that you meet with our management team to see if we can assist you with these issues. We have many resources that we can call up to assist you. If your concern is one with our operations, please know that our classrooms, playgrounds and swimming areas are digitally recorded and we can schedule to watch for any concerns you may have. With counseling and viewing the tape a lot of assumptions can easily be cleared up or a plan can be implemented.
*We require a two (2) weeks in writing (which equals two full weeks of tuition paid for each child) if you plan to withdraw our child from our program.
DISCIPLINE PROCEDURESDacula Academy will use a positive discipline policy. The following procedures will be followed:
1. Verbal Warning by Instructor.2. 123 Magic Effective Discipline for ages 2 through 13. Count Down Program.3. Removal from activity and taken to another classroom.4. Individual counseling.5. Child sent to front desk for individual counseling.6. Parent/Instructor/Director conference.7. Removal from program.
All children are expected to follow the rules established by Dacula Academy. School Age children will be asked to sign a behavior contract at time of enrollment. We reserve the right to dismiss your child from our program if the above measures fail.
EMERGENCY MEDICAL PLANThe staff of Dacula Academy will administer first aid for minor injuries. If we feel your child has received a serious injury or illness, the following emergency plan will be followed:
1. Call local Emergency Medical Service (EMS)2. Transport to nearest hospital by (EMS)3. Call Parent4. Contact Emergency Contact if parent cannot be reached.
The emergency medical facility used by Dacula Academy is Gwinnett Medical Center. Parents are responsible if medical attention is necessary.
MEDICATIONPARENTAL AUTHORIZATION
Medication will not be given without proper authorization. All medication must have child’s name, date, dosage, prescription number and time medication is to be given. All information must be on the medicine bottle. A medication form must be completed for all medication. These forms are good for two weeks. We will dispense medication at 10:00AM and 2:00PM. If your child requires medication at different times, please see the Director or Assistant Director for special arrangements. We will not dispense any medication without a doctor’s note. This includes Tylenol and Motrin. The doctor’s note must include child’s name, date, and amount of medication to be given and dates to be given. All medication must be in the original container. If medication must be refrigerated, please see someone at the front desk. Do not leave medication in your child’s bag. All medication must be kept at the front desk. Medication will be discarded one week from the last date to be administered. Parents will be notified if child shows any adverse reaction to medication.
DISPNESING MEDICATIONWritten authorization to dispense medication shall be limited to two weeks unless otherwise prescribed by a physician. Medication shall only be dispensed out of its original container, which must be labeled, with the child’s name. The director or assistant director shall be the only staff dispensing medications.
DISPENSING RECORDSThe center shall maintain a record of all medications dispensed to children by personnel to include the date, time and amount of medication that was administered; any noticeable adverse reactions to the medications; and the signature or initials of the person administering the medication.
STORAGEMedications shall be kept in a locked storage cabinet or container which is not accessible to the children and stored separate form cleaning chemicals, supplies, or poisons. Medications requiring refrigeration shall be placed in a leak proof container in a refrigerator that is not accessible to the children.
UNUSED MEDICATION
Medicines, which are no longer to be dispensed, shall be returned to the child’s parents immediately.
NON-EMERGENCY INJECTIONSOnly appropriately licensed persons shall administer non-Emergency injections unless the parent and physician of the child sign a written authorization for the child to self-administer the injection.
ILLNESS/COMMUNICABLE DISEASESAny child who is ill will not be accepted. If your child becomes ill at school, you will be notified and expected to plan for pick up within an hour and a half. Any child who has diarrhea, vomiting, sore throat or a temperature over 101 degrees may not remain at the center. If your child has any of the above symptoms, they must remain out of the center until they are symptom free for 24 hours. We reserve the right to refuse admission.We will notify parents of any suspected communicable disease. Children who have had a communicable disease will not be readmitted without written consent from their doctor. A list of communicable diseases is posted on the front bulletin board.
TRANSPORTATION
Dacula Academy will provide transportation to and from school and on planned field trips. Parents must sign a permission slip for every field trip. A school transportation form must be signed at the beginning of every school year for transportation on county public school transportation. If your child is transported to or from school, we will not leave children at drop off site without proper supervision. In the event, no one is at the drop off site, the driver will take the child back to Dacula Academy children with special needs will be escorted to and from their bus by a facility member.
EVACUATION PLANIn the event of severe weather, fire or physical plant problems, children will be evacuated from the building and parents notified immediately. Emergency plans are in every room and the front desk. If you have any questions regarding these plans, please see the Director, Assistant Director or your child’s teacher. Fire and tornado drills will be held on a regular basis. If we find that we need to evacuate our building, we will transport all children and staff to Harbins Elementary School and parents will be contacted for pick up.
DIETWe do not allow outside food in the center due to children’s allergies and safety. If your child requires a modified diet for medical reasons, a written statement from a medical authority must be on file. When a child’s diet must be modified for religious reasons, a written statement to that effect from the child’s parents must be on file. Only food that complies with the prescribed dietary regiment but still meets the food and nutrition requirements shall be served to the child. If your child is allergic to any foods, the center must be notified in writing and a copy will be posted in the kitchen and the child’s room. Please watch the posted menus for foods your child may be allergic to. If your child requires a special diet, you will be responsible for providing the necessary food and they will be served in the café area away from other children for allergy and safety reasons.
BIRTHDAYS
We do not allow outside food in the center due to children’s allergies and safety. Vanilla Ice Cream is served each month recognizing any birthdays in each classroom. Parents are more than welcome to provide goody bags that children can take home to their parents.
INFANT CAREFor the health and safety of all infants, we ask that only parents of infants and the staff at Dacula Academy enter the infant rooms. Please do not allow siblings into the room. Parents must provide Dacula Academy with enough prepared bottles to feed for the entire day. We will not mix or prepare formula for bottles. All bottles must be labeled with child’s first and last name and date. All bottles must have covers for nipples.
Parents are responsible for providing diapers and baby food.
MEDIA RELEASE
Dacula Academy uses and releases photographs, audio recordings, and/or video recordings taken or recorded at its facility and events for educational, instructional, or promotional purposes as determined by Dacula Academy for use in broadcast and media formats now existing or created in the future. These photographs and recordings often include depictions of students and/or parents engaged in school functions and activities. Any such photographs, audio recordings, and/or video recordings shall become the property of Dacula Academy and may be used by Dacula Academy or others with the consent of Dacula Academy and/or its representatives. As the parent of a student, you may elect to withhold your consent for Dacula Academy’s use of photographs, audio recordings, and/or video recordings of you and /or your child. To withhold your consent, for the disclosure of you and/or your child’s photographs, audio recordings, and/or video recordings, the parent of the student must notify the Directors of the school the student attends in writing within 10 days of receipt of this handbook. The written notice must: (1) include the name of the student; (2) include a statement that the parent/guardian is opting out of the release of photographs, audio recordings, and/or video recordings depicting the student; and (3) be signed and dated by the parent, guardian. Please note that your written notice will be effective for the current school year only and must be renewed on an annual basis should you wish to continue to opt out of the release of photographs and recordings. Finally, please note that Dacula Academy will not be responsible for, and cannot control photographs, audio recordings, or video recordings captured by individuals who are not employed by, affiliated with, or under contract with Dacula Academy.
GENERAL
DIAPER/BACK PACKS: Preschool or Pre-K children are not allowed to have diaper bags or back packs in the classrooms. Extra changes of clothes, diapers, etc. are to be placed in a large zip lock bag inside the child’s cubby with the child’s name on the bag. Please make sure all coats, hats and gloves have your child’s name marked on the inside of them so they will not be lost.
PARKING: It is unsafe for you to leave you vehicle running in the parking lot. It is unsafe for you to leave a child unattended in the parking lot.
CAR SEATS: It is against the law for you to leave our parking lot with any child under the age of 8 not restrained in a car seat.
SMOKING: Smoking is not permitted anywhere on this property including your vehicle while it is on this property.
FENCES/GATES:
No one is permitted to pick up children by entering the fenced or gated areas.
I have completely read and understand the above policies of Dacula Academy of
Preschool and Child Care, Inc. By signing the policies and procedures, I agree to abide
by all policies stated above. I also agree by signing these policies that I have been
given a copy of the policies and a copy has been placed in my child’s file.
If our program is not suited for your child’s personal needs or the parent’s desires, we reserve the right to terminate services.
