Enrollment

PARENT/GUARDIAN 1

Name*

First Last

Email*

Relation to Child:*

Employer:*

Phone 1:*

Phone 2:

Phone 3:

Address:*

Street Address City State ZIP Code

CHILD 1

Name*

First Last

Sex*

Male

Female

Birthdate:*

Month

Day

Year

Location*

Start Date:*

Month

Day

Year

Type Of Care*

Which days of the week would you like to attend?*

Monday

Tuesday

Wednesday

Thursday

Friday

Allergies*

Yes

My Child Is Allergic to:*

Add More

Enroll Child 2

CHILD 2

Name

First Last

Sex

Male

Female

Birthdate:

Month

Day

Year

Location

Start Date:

Month

Day

Year

Type Of Care

Which days of the week would you like to attend?

Monday

Tuesday

Wednesday

Thursday

Friday

Allergies

Yes

My Child Is Allergic to:*

Add More

Enroll Child 3

CHILD 3

Name

First Last

Sex

Male

Female

Birthdate:

Month

Day

Year

Location

Start Date:

Month

Day

Year

Type Of Care

Which days of the week would you like to attend?

Monday

Tuesday

Wednesday

Thursday

Friday

Allergies

Yes

My Child Is Allergic to:*

Parent Consent

Parents/Guardians must carefully read the following information and initial where indicated. A signature following the initials is also required. The Parent Handbook can be found on our website:

https://rockymountainpreschool.com/parent-handbook/ (use code RMP).

Policy

1. Emergency Procedure:*

In case of emergency, I authorize the Center to contact guardians or emergency contacts from my Kangarootime account. If a parent/guardian cannot be contacted, the Center’s employees are authorized to take necessary action for the health and welfare of my child.

2. Parent Handbook:*

I understand and agree that when I register my child, I must abide by the policies and procedures stated in the Parent Handbook. I have received, read, and understand the Parent Handbook. I agree to be responsible for, comply with and abide by the procedures as stated therein. I understand RMP policies and procedures are subject to change and that I will be notified of any changes.

3. Center Hours:*

I understand the Center is open from 6:30 a.m. – 6:00 p.m., and as a courtesy to the RMP staff, I agree to arrive in time to exit the Center no later than 5:30 p.m. I also understand Nursery hours are from 7:00 a.m. – 5:30 p.m. I agree to abide by those hours and pay $5/min. as a late charge based on RMP’s late policy in the Parent Handbook. Part-time students can attend up to 5 hours a day and full- time students can attend up to 10 hours a day.

Drop-off time:*

Pick-up time:*

4. Sign-In/Sign-Out Procedure and Responsibility:*

I agree to abide by the Sign- In/Sign-Out procedures as stated in the Parent Handbook. This includes dropping off my child before 9:30am and avoiding pickup during naptime hours for my child’s classroom. I understand RMP is not responsible for my child enroute to the Center before they are correctly signed in or enroute to their home after being correctly signed out. I will review the sign-in and sign-out procedure with anyone authorized to pick up my child.

5. Student Records Updates:*

I agree to keep my child’s records up to date, including but not limited to, current home and work phone numbers and numbers of those authorized to pick up my child, immunizations and general health appraisal.

6. Movies:*

I give permission for my child to watch ‘G’ rated movies.

7. Photo/Video Consent:*

I give permission for my child to be included in photographs and/or videos that may be taken in the course of daily activities that can be displayed at the center, shared with parents, and used for the marketing of the program.

8. Sleeping on Cots:*

I give permission for my child to sleep on a cot above floor level during nap time.

9. Transportation:*

I understand RMP does not do field trips or provide transportation to/from the Center.

10. Food Program:*

I understand RMP follows the Child and Adult Food Care Program, and that RMP is a peanut-free center.

11. Sunscreen:*

I understand it is my responsibility to apply sunscreen to my child each morning before bringing them to school. I give my permission for RMP staff to supervise and/or re-apply sunscreen to my child(ren) each afternoon as needed when out in the sunshine. RMP uses Rocky Mountain SPF 30+ hypoallergenic sunscreen. There is no additional charge for this service.

If you have a child in diapers, please check box #12. If not, skip this box and proceed to #13.

12. Diapers:

I understand it is my responsibility to supply enough diapers for my child and understand the Center will give me sufficient notice to replenish my supply. If diapers are not available for my child, services will be suspended until a new supply is obtained.

13. Tuition/Fees:*

I agree to pay tuition and fees in full by Monday of each week. This includes a return check fee of $25 and a fee of 2 weeks tuition will be charged for early termination. Payments made for tuition and fees are non-refundable. Should tuition and fees not be paid as agreed herein, child care services are subject to termination on Wednesday of the same week.

14. Contact Information:*

I have checked my family’s contact information and I verify with my initials that the information is up to date including our address, phone numbers, and people authorized to pick up my child(ren).

15. Parent Code of Conduct:*

I have read, understand, and am willing to abide by RMP’s Parent Code of Conduct contained in the Parent Handbook and posted at the center. I understand that failure to abide by this code could lead to termination of services.

Activities my child should not participate in:

The information in your child’s records is considered privileged and confidential. No one who is not directly related to the care of your child, or with Center management or the State licensing agency, will have access to the record without your written permission. As a parent or guardian, you may have access upon request.

By signing below, I acknowledge that I have received, read, understand, and am willing to abide by RMP’s Parent Handbook and this Parent/Guardian Consent Form. I also acknowledge that I have been given the opportunity to ask questions.

Coupon Code

Parent Signature*

Date*

Month

Day

Year

CAPTCHA

PARENT/GUARDIAN 1

CHILD 1

CHILD 2

CHILD 3

Parent Consent

Parents/Guardians must carefully read the following information and initial where indicated. A signature following the initials is also required. The Parent Handbook can be found on our website:

Policy

If you have a child in diapers, please check box #12. If not, skip this box and proceed to #13.

By signing below, I acknowledge that I have received, read, understand, and am willing to abide by RMP’s Parent Handbook and this Parent/Guardian Consent Form. I also acknowledge that I have been given the opportunity to ask questions.

Willow Creek Campus

Dove Valley Campus

Have Questions?