Add a Child Form Add A Child FormEnrolled Child(ren)'s Information*Child’s NameDOBClassroomTuition RateSibling DiscountActual Tuition Days of Week Attendance* Mon Tues Wed Thurs Fri Enrollment Start Date* Date Format: MM slash DD slash YYYY Normal Tuition Quote/ MonthProrated TuitionLittle Scholars Academy ContractWe have 3 payment plans, please select one:*Plan 1: Tuition will be paid once a month in full on the 1stPlan 2: Tuition will be paid once a month in full on the 15thPlan 3: Tuition will be divided into two payments; half will be due on the 1st of the month and the remaining half will be due on the 15th of the month.If one of these payment plans doesn't work for your situation, please speak to the office manager about making other payment arrangements and we will work with you if possible. If the 1st or 15th happen to fall on a weekend, you will be required to pay on the following Monday. The three-day grace will start on that date. ICCP participants must recertify on time. It is the participant's responsibility to obtain the proper paperwork, have it filled out by one of the directors/assistants, and turn it into ICCP accordingly. If you fail to do so, you are responsible for your tuition in full, until it is reinstated. ICCP participants MUST pay their copay during the month of service, failure to do so will result in termination of your childcare and 20% of the total balance will be added to your bill. The reason for this being this is the fine ICCP will charge LSA for Co-pays collected late or not at all. All account balances must be paid in full during the month they are charged, zeroing your account out by the end of the month. If you carry a past due balance of $500 or higher, your childcare will be terminated and you will have 20 days to pay the remaining balance before an unpaid account fee will be added and turned over to collections. In the event that the account becomes delinquent and payment is not made on accounts owing under the terms of this agreement, and the balance is placed with a licensed collection agency and all parties on contract agree to pay the fees of the collection agency which amount is therefore agreed to be 50% of the outstanding balance at the time the account is placed for collections. The 50% collection agency fee will be calculated and added at the time the account is placed into collections by the client. After attending our childcare facility for six months, your family is given 1 week (5 consecutive days) vacation. Once you have been in attendance for a year, you are given 2 weeks (10 consecutive days or 2 separate periods of 5 consecutive days) vacation. Vacation is to date of enrollment, if you did not use your 2-week vacation in your year, it will not roll over. If vacation has been used, it will begin again the day after the anniversary date. As well as, in order for you to be eligible for your vacation YOU MUST be on time with your payments and not in default for more than 15 days. You are required to give our staff a 2-week notice when using your vacation time, 30-day notice if on ICCP. Your vacation rate is determined by your monthly tuition, divided into the number of days for the month in which you vacation. We then take off the cost of the vacation accordingly. To request vacation time a "Parent Vacation Request Form" must be filled out and submitted. Failure to give proper notice may result in your vacation credit being declined. As your child progresses at our facility, your tuition will change accordingly, i.e. age and or attending school. Any questions you have on what these rates will be, and when exactly yours will take effect can be answered by the office manager. Please note that rates are subject to change at any time and changes to the rate prior to child being of that age will apply. There is a $20 Pre-school fund that you are required to pay once every three months (March, June, September, and December). This is for children 1-5 years of age that attend ones through preschool to cover extra sensory, and party supplies. We ask that you pay this by check or cash, separate from your tuition, and cannot be billed to ICCP. If at any point you decide to remove your child from our care, you must provide a minimum two-week written notice, regardless of the reason for pulling from our care. You will, upon the receipt of your notice be given your prorated remaining balance which will be due by your last day. Please note vacation time cannot be used as payment for a final two-week notice. If you do not give notice, you will be responsible to pay the full tuition for the next 30 days.Agreed to on* Date Format: MM slash DD slash YYYY Parent Name* First Last Parents signature*Reset to re-sign.Payment PreferencesPreferred Payment Reminder Method:* Note Text Email Preferred Method of Payment*In personOnlineAutomaticIn-person*CheckCashCredit CardOnline (Tuition Express)*Credit CardACHA link to set up your Procare Tuition Express account for online payments will be emailed to you once this enrollment packet has been reviewed.Automatic*Credit CardACHTuition Express Autopay AgreementConsent* I (we) hereby authorize Little Scholars Academy to initiate credit card charges to the below-referenced credit card account (Section A) OR, initiate debit entries to my (our) checking or savings account, indicated below (Section B). To properly affect the cancellation of this agreement, I (we) are required to give 10 days written notice. Credit Union members: please contact your credit union to verify account and routing numbers for automatic payments.(Credit/Debit Card)Cardholder Name*Phone #*Billing Address* Street Address City State / Province / Region ZIP / Postal Code Card Number*Exp. Date*CVV*Cardholder Signature*Reset to re-sign.Date* Date Format: MM slash DD slash YYYY ACH (Bank Account)Must Attach a Voided Check* Drop files here or Your Name*Phone #*Billing Address* Street Address City State / Province / Region ZIP / Postal Code Bank Name*Bank Address* Street Address City State / Province / Region ZIP / Postal Code Routing Transit Number*Account Number*Type*CheckingSavingsAuthorized Signature*Reset to re-sign.Date* Date Format: MM slash DD slash YYYY Consent* I also give LSA permission to run my Child’s preschool fund on the 1st of March, June, September, and December in the amount of $20 per child ages 1-5Signature*Reset to re-sign.Emergency Contacts & Authorized Pick UpsMy Emergency Contacts/Authorized Pick ups are correct in Procare to be carried over for my newly enrolled child* Yes No Is anyone legally restricted from seeing your child/children?*YesNoIf yes please attach court documentation, we are, by law required/ordered to follow ALL court orders.* Drop files here or Parent’s Signature*Reset to re-sign.Date* Date Format: MM slash DD slash YYYY Emergency Medical InformationChild(ren)'s Doctor*Phone*Insurance Co*Policy#*Name of Insured*Insured SSN*We do not enroll children who are not fully immunized, is your child(ren) registered with IRIS?*YesNoIf "No" a paper copy of up to date immunizations is requried for licensing documentation.Consent* I verify that the medical information listed is complete and accurate.Signature*Reset to re-sign.Date* Date Format: MM slash DD slash YYYY LSA Medical Emergency Release and Liability FormChild(ren)'s Name(s) I hereby give my permission for Little Scholars Academy or a representative of the staff to give CPR, to call the child(ren)'s physician, to secure necessary medical care (including the administration of anesthesia if surgery is advised}, to call an ambulance to transport the child to the hospital of their choice, and to otherwise act in my behalf to protect my child if I cannot be reached and/or when delay would be dangerous in case of illness or accident all at my own expense. Unless proven full neglect regarding the attending staff. The undersigned(s) being the lawful parent(s) and/or guardian(s) of the below child, hereby consent to the participation by the child in all day care activities conducted by Little Scholars Academy, herein referred to as LSA, and to the participation of the child in all events related to said activities. The undersigned(s) hereby further authorize(s) emergency transportation by either day care personnel or if necessary by ambulance or other emergency vehicle. I hereby give permission for child care program to transport my child, to an emergency relocation site for staff, teachers and children when it is unsafe to remain at the child care facility. I understand that normal safety rules will be followed, as much as possible, but that the highest priority is to relocate to a safe location. I hereby authorize Little Scholars Academy and its staff to transport all school aged children to and from their enrolled school, knowing that they only transport to certain schools and the school transportation is available to is subject to change at any time. Little Scholars Academy acknowledges that all staff that will be driving LSA vehicles are Boise City Childcare Licensed, 1st Aid and CPR Certified, have valid Driver’s Licenses, and all LSA vehicles are currently insured and have an updated Registration. If there is no medical emergency, the day care staff will first use reasonable efforts to contact the parent(s) and/or guardian(s) before administering or authorizing any treatment. The day care is well child-proofed and the children are consistently well supervised; however, accidents do happen. The undersigned(s) assume(s) all risk of injury or harm to the child associated with participation in the day care and agree(s) to release, indemnify, defend and forever discharge LSA and its staff, employees, and agents of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action in respect of death, injury, loss or damage to the child, or by the child, howsoever caused, arising or to arise by reason of or during the child's participation in the day care. The undersigned(s) acknowledges that when the party responsible for dropping off/picking up their child(ren) is on the premises, that party is also responsible for the actions of the child(ren), and that attention needs to be paid to be sure the child(ren) are where they need to be and they are not performing any actions that may result in injury or damage, to themselves, others, or any property.Check the box beside the statement:* I have read and understood the statements above. Parent’s Signature*Reset to re-sign.Date* Date Format: MM slash DD slash YYYY LSA Admission AgreementAs your child(ren)'s daycare provider, we agree to: • Give your child(ren) careful attention, affectionate care, and stimulating things to do, such as craft time, story time, nap time, and outside play with weather permitting. • To provide your child(ren) a safe and loving environment • Supplement parent provided food if needed with nutritious snacks and beverages. • Keep you informed of your child(ren)'s activities, growth, and any problems. As a parent, I agree to: • Provide a snack and a lunch. If I do not provide a lunch I understand that the childcare will provide a lunch for my child, with the understanding I will be responsible for replacing that lunch with either another one or pay a charge of $1 .5 0 which will be added to my monthly tuition. • Provide an extra set of clothes and any special equipment, such as diapers, formula, etc. to make the child(ren)'s day run smoothly. • Inform the daycare if someone else other than the parents will be picking up the child(ren). • Report any changes of address or phone number of home or work. • Inform the daycare in advance if the chìld(ren) cannot be brought or picked up at the scheduled time by 1 1 a.m. • Inform the daycare two weeks in advance before removing the child(ren) from the daycare if not daycare tuition will still be held liable for next 3 0 days. • Provide payment by no later than selected contract due date according to the childcare cost sheet st th whether the child(ren) attends or not. Payments are due on the 1 and/or the 1 5 of each month, unless prior arrangements are made. There is a 3 day grace period if payment is late, after 3 days there is a $1 5 .0 0 a day late charge that will be added to your bill, and will back date to the original due date. • I understand that there is a $1 .0 0 per minute per child late charge after 6 p .m. and early charge before 7 a.m. and on the 3 rd offense this will be increased to $5 .0 0 per minute per child charge from there on. Payable with my next monthly tuition. Regular tardiness is subject to childcare termination. And we ask that the child(ren) does not bring gum, hard candies and money to daycare. Thank you!! Thank you for giving us the privilege to be a part of your child(ren)’s life and we promise to do our utmost to hold ourselves to your expectations.Check the box beside the statement:* I have read and understood the statements above. Parent’s Signature*Reset to re-sign.Date* Date Format: MM slash DD slash YYYY Permission to Give OTC Medication at LSA (Over The Counter Medicine Form) Child(ren)'s Name(s) Consent* I hereby give Little Scholars Academy Employees permission to apply or give one or more of the following over the counter medications or external preparations, in accordance with the directions for use on the container:Oral Medications: Tylenol Motrin, Advil, or Ibuprofen Benadryl- for bee stings only Specify how you would like these to be used.*At LSA discretion, with a notice sent at the end of the dayAt LSA discretion, with a phone call message notifying parent of useWith verbal permission by phone call for each incidentTopical Medications: These will be administered as needed and parents will be notified at the end of the day. Band-Aids Neosporin, Bacitracin, or similar ointment Bactine or similar first aid spray Parent Provided topical application: These will administered as needed without individual notification Non-Prescription Ointment (Such as A & D, desitin, Vaseline)* Baby Powder* Baby Lotion* Baby Wipes* Other Other: (please specify)*Special Instructions Note: If the instructions for administering the medication, cream, etc. are not printed on the container (such as with Tylenol for children under 2), then I need a form from the child's doctor indicating the appropriate dosage to be given. Consent* I hereby request that Little Scholars Academy administer one or more of the above over the counter medications or external preparations in accordance with the directions on the container as needed. This consent is valid for the duration of your enrollment at LSA. I may withdraw this request at any time.Consent* I release Little Scholars Academy and its employees from any liability for administering these preparations.Parent’s Signature*Reset to re-sign.Date* Date Format: MM slash DD slash YYYY Photo Release FormAs the parent of a child/children at Little Scholars Academy, I agree to the following: • I understand that my child(ren) whose name(s) are listed below may be photographed at Little Scholars Academy during normal daycare hours, field trips or activities. • I understand that these photographs may be used in promoting child care services, either in print or on the internet. • I understand that these photographs may be used in school newsletters or mounted on the Little Scholars Academy website, Facebook or any other publication • I give permission for my child(ren)'s photographs to be mounted on Little Scholars Academy's website, Facebook, newsletters, or any other publication. (When names are added, only first names will be used.) • I understand that I have the right to request, in writing, to have a photo removed from the website or Facebook within 3 0 workdays. • I understand that it is my responsibility to update this form in the event that I wish to change the authorization given on this form. • I agree that this form will remain in effect during the term of my child(ren)'s enrollment. • I understand that there will be no payment for me or my child(ren)'s participation. Check the box beside the statement:* I have read and understood the statements above. Child(ren)'s Name(s) Please Select ONE of the following:*Yes, I confirm that I have read and understood the above, and agree to have my child(ren)'s photos mounted on the Little Scholars Academy website, Facebook page, newsletters or any other publication.Yes, I confirm that I have read and understood the above and agree to have my child(ren)'s photos mounted only to print publications, such as newsletters, brochures, and on site bulletin boards, or any other print only publications. Photos may not be used for any electronic publications such as a website or Facebook.No, I do not wish to have my child(ren)'s photographs published for advertising purposes, I understand that pictures may still be taken and displayed within the building for art projects, but that they will only leave the building with the parent/guardian.Signature*Reset to re-sign.Date* Date Format: MM slash DD slash YYYY SUNSCREEN PERMISSION FORMParents, We ask that all families provide 1 bottle of sunscreen per child per year to help us keep everyone protected during the summer and sunny months. If your child has a sunscreen allergy or you have a preference on what sunscreen is used due to health reasons you must provide that specific brand to be used ONLY on your child, otherwise we place all sunscreen in a community container and use them on at a time on all children.Child(ren)'s Name(s) Please mark which you have provided below*A bottle for everyone to use (please do not put their name on it)A bottle specific to my child due to health reasonsPlease do not place sunscreen on my child.Consent* I understand that if my child has an allergy to any sunscreen I must provide Little Scholars Academy with the preferred sunscreen and consistently replace it.Check the box beside the statement:* I have read and understood the statements above. Signature*Reset to re-sign.
