Health Section
For your convienence, and to expediate the application process, Select the form that is appropriated for your child below,Print out and fill , sign and bring them to your first appointment. Because we value your child/children's safety we advice you to complete the form that is applied to you.
You will be asked about the form when you come for enrollment, to avoid unnecessary delays please proceed below and print the appropriate form for you child/children .
You will be asked about the form when you come for enrollment, to avoid unnecessary delays please proceed below and print the appropriate form for you child/children .
General School Enrollment Form
Child's Name: ______________________________________________
Childs' Date of Birth: ________________________________________
Parents:
Mother’s Name:_____________________________________________
Mother Home Phone: ________________________________________
Home Address:________________________________________________________________________
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Mother Work Phone:_________________________________________
Mother Work Address:____________________________________________________________________
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Mother’s Occupation:_________________________________________
Mother Cell Phone:___________________________________________
Father’s Name:______________________________________________
Father Home Phone:__________________________________________
Home Address:_____________________________________________________________________________
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Father Work Phone:___________________________________________
Father Work Address: _________________________________________________________________________
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Father’s Occupation:__________________________________________
Father Cell Phone:____________________________________________
Other friend or relatives your child may be released to/or picked up by:
Name: _________________________________Surname____________________________________________
Phone: ____________________________________________________
Name: _________________________________Surname____________________________________________
Phone: _________________________________Surname____________________________________________
Name: _____________________________________________________
Phone:_____________________________________________________
Doctor information:
Name of Doctor:Name: _________________________________________
Address 1: _________________________________________________________________________________
Address 2: _________________________________________________________________________________
Phone: ______________________________________________________
Comments: ____________________________________________________________________________________
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_____________________________________________________________________________________________
Daycare Hazard Plan Form
Daycare Hazard PlanThe Daycare hazard plan for our facility states that during daycare, your children will be supervised at all times by an adult. Children will be protected from all hazards such as: chemicals and cleaners (our cleaners are stored out of reach or under lock and key). We have safety gates on the stairs , and we keep the children in two designated playrooms with safety gates while being supervised. There are also safety locks on doors and cabinets to keep the children out of unauthorized places. While outside, the children are in a fenced yard, and away from all traffic..
Discharge Policy Bsec requires that all daycares have a written discharge policy in the event that a parent or guardian does not retrieve, or arrange to have someone retrieve their child by their designated agreed upon time. Our business hours end at 5 pm, and unless arrangements have been made for your child to stay later, someone should always arrive and pick-up their children no later than 5.30 pm. Should you not be able to meet that deadline and are unable to call to inform us of your delay the following consequences for not picking up your child on time will be: a late fee of $15.00 for every 30 minutes that you are late. If you are not here or have made plans to pick-up your child by 8pm, the daycare will attempt to reach your emergency contacts, if no one can be available to pick- up your child, the appropriate authorities will be notified, which includes police assistance.
Name______________________________________ Surname________________________________________
Tel_____________________________________________________
Address____________________________________________________________________________________
Parents signature:___________________________________
Date:__________________
First Day Requirements Form
Requirements for First day of Daycare:
____________YES / NO______________ All paperwork signed and dated?
Your first weeks tuition, due on the day you start & your start up fee, we take up front to hold your slot, and purchase your child’s supplies.
All shot records and last physical report from your child’s doctor – required by Bsec
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At least one change of clothing for warmer and colder weather to be kept in cubby.
A toothbrush
Summertime Necessities: ________________________ sun-tan lotion, Diapers and Anti - Rash powder (infants only)
Optional: _________________________________________change of shoes
Infant Necessities:
______________________________ Formula
______________________________ Baby food
______________________________ Infant cereal
______________________________ Diapers
______________________________ TWO changes of clothing
Optional: __________________________________ Baby Tylenol/Aspirin & Teething Ring or Gel
Optional: __________________________________ Infant snacks, finger puffs, crackers etc.
Optional: __________________________________ nursery water
Other items (Optional) Please list: ___________________________________
We ask that you do not bring toys to daycare. We cannot be responsible if they get lost or broken.
All unused portions of the items that you bring will be returned to you, either when they are no longer needed, or if you should leave our daycare, with the only exceptions being the paper work you orginally filed with us and tuition fees.
Bsec Daycare does not provide infants with feeding bottle or (formula ), We might provide a pack n’ play, a blanket, their own personal cups, plates, bowls and car seat. These items will remain at Bsec's location.
I have provided the required necessities for daycare and understand that I am responsible for continuing to provide all neccessities until my child is no longer in need of these items.
Parent Name______________________________________ Surname__________________________________
Parent signature ___________________________________
Tel_____________________________________________
Date __________________________________________
I understand that the Bsec Daycare center will provide all meals and snacks to children who are on a normal diet of table food. If my child/children require a special diet, I will provide those particular items to fulfill my childs needs.
Parent Name and signature_______________________________________________________________
Sign Here________________________________
Date____________________________________
Daycare Enrollment Form
Child’s Full Name: __________________________________________
Child's Nickname: __________________________________________
Date Child will begin attending: __________/__________/____________
Status:
(Please Check One):
Full Time ________________________________
Part Time _________________________________
Occasional Babysitting/Temporary Care ___________________________________________
Monday______________ Start time ______________End Time____________
Tuesday______________ Start time ______________ End Time_________________
Wednesday____________ Start time ______________ End Time_________________
Thursday______________ Start time ______________ End Time_________________
Friday_________________ Start time ______________ End Time_________________
Saturday_______________ Start time ______________ End Time_________________
Sunday________________ Start time ______________ End Time_________________
Please consider your travel time and allow room for traffic situations. If you arrive prior to your scheduled drop off time or arrive after your scheduled pick-up time extra charges will occur.
Click here for day care fees
(To be charged a ½ day rate you must pick one : 6am to 12 or 12 to 6 pm )
The Part time hourly rate for one child $ 9.00 an hour Contact us for our seasonal discounts!
All tuition charges are payable by Monday MORNING (of each week) at drop off time in cash on the first day the child starts. Any time after Monday morning is considered late. A late fee of $15.00 will be assessed for late payments. If payment becomes more than a week late, the child may not return to daycare unless tuition is paid in full and current. There is a one time fee at the time your child begins daycare. This fee covers the start up costs for your child’s personal belongings here at the daycare center. If you are part-time or occasional babysitting parent then you will be required to pay on the first day your child attends daycare for the week. Payment will always be due when you drop off your child, NOT when you pick them up.
I have received a copy of the center’s policies and procedures and agree to the terms and policy . I agree to pay the amount due for the time my child is enrolled. I understand that I may withdraw my child at any time by giving two weeks notice to the center. If notice is not given you will be required to pay for one weeks of tuition on the last day your child or children attend daycare. All personal belongings will be returned on the last day when all daycare tuition charges are paid in full and there is no remaining balance owed.
By submitting this form, I agree to the terms stated above.
Name: __________________________________________ Surname_____________________________________
Address_________________________________________
Tel____________________________________________
Date: _________________________________________
Parent or Guardian Signature__________________________________________
Absent/Late Policy
Our Daycare is open from 6am-5pm Monday-Friday. Childcare can be available on a needed basis outside these hours if requested for a different rate.
Late fees - We understand emergencies, and will allow 2 late pick-ups per month. After that we do charge $2.00 per additional 15 minutes that you are late.
Sick time - We understand colds and try our very best to keep from sharing sickness however, Bsec requires that children who are sick with the flu and/or have a fever of 100.0+ or children who may be contagious to other children be kept at home. Our fees remain the same even if they are not here. If children become sick or develop a fever during the day, they will be separated from the other children until you arrive to pick them up. If it is early in the day, we will have to call you and arrange for an early pick-up.
Applies to Full Time only: Vacations – You may take vacation any time you like, to hold your child’s daycare position while you are on vacation you must provide prior notice of your child’s absence and regular fees apply and must be paid prior to your vacation. If we take a vacation we will give at least one month’s notice and our regular fees will apply during our vacation week.
Holidays - We are open year round with the exception of New Years Eve, New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day & the Friday following, Christmas Eve, Christmas Day, the day after Christmas and Khmer holidays.
Fees for Holidays and Days closed - The holidays listed above are paid holidays. Your regular rate will be charged for the holiday, if they fall on a Mon-Fri.
Substitute care – If we do not close the center but need time off for appointments that cannot be made during the evening or weekends we may need to have substitute care.
Part-time –vacations, holidays and fees for these days do not apply unless the holiday was a day your child would have normally been at daycare. For example if your child attends daycare on Mon, Wed & Fri and Labor day is on a Monday you would have to pay for Monday as if your child were here. If you are normally not scheduled on Mondays then this rule does not apply to you.
Extra Days Needed - If your child is not scheduled to attend daycare but you need child care for that day, you may call the center for availability. If the space is available the center will be able to accommodate your child care needs for that day. Your regular rate will be charged for the extra day.
I agree to follow the Center’s Absence Policy.
Parent Name___________________Surname__________________________________________
Tel_______________________________________________
Parent Signature:_______________________________________
Date:______________________________________________________________
Medical Information and Child Preferences Form
Does your child have any allergies? (food, medication, animals, nature):
Yes ______
No ______
If yes, please list:
______________________________________________________________________________________________________
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Respiratory Problem E.g does your child have an inhaler?
Yes ______
No ______
If yes, will they be bringing it to daycare on a daily basis?
Yes ______
No ______
Does your child know how and when to use the inhaler?
Yes ______
No ______
If no, do you wish for us to help them if they need help?
Yes _______
No ________
Does your child have epinephrine pen?
Yes _______
No ________
If yes, will you be keeping it here at daycare or bringing it with you on a daily basis?_______________________________
Will you leave pen with Bsec Daycare? ___Yes_____/_____No____
In an emergency do you wish for us to help your child give them medical first aid till you come for further assistance? If yes, please sign on the line below.
__________________________________ Signature Date_______________________
Name______________________________________ Surname_____________________________________________
Does your child have any other medical conditions ?
Yes ______
No ______
If yes, please explain:
______________________________________________________________________________________________________
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Does your child take any medications ?
Yes ______
No ______
If yes, please list:
______________________________________________________________________________________________________
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Do we need to give your child any medications while he/she is in our care?
Yes ______
No ______
If yes, please explain
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Name of medication: __________________________________________________________________________________
Amount: _____________________
Frequency: __________________
Special instructions (take with food etc.):
______________________________________________________________________________________________________
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Does your child take naps?
Yes______
No ______
If yes:
Length of nap: ______________________
Time of nap: ________________________
Morning time: ________ Afternoon time: ________
What time does your child typically go to bed? _________________Am/_________________Pm_
Does your child have a pacifier, stuffed animal, or special way of taking naps that we should know about?
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Is there any foods that your child will not or you wish for he/she not to eat? If yes please list:
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Has your child ever experienced separation anxiety? If yes, please explain and how did you handle it?
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What is your child(s) favorite food?
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What is your child(s) favorite toy?
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What is your child(s) favorite movie/show?
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Does your child like craft projects? If yes, Please explain:
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Important!
Help us to know your little one. Tell us anything you would like us to know. For infants, this is a great place to tell us about
his/her current feeding schedule. How often does your child eat, and how many ounces does he normally drink:
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Comment:
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Thank you !
Bsec