Child Information Sheet
Child’s Name:______Birthday:______
Address:______
Phone Number: ______
Mother’s Name: ______Home #:______
Address: ______Cell #: ______
Business Name: ______Work #: ______
E-mail Address:______
Father’s Name: ______Home #:______
Address: ______Cell #: ______
Business Name: ______Work #: ______
E-mail Address:______
Person to be contacted in case of an emergency or illness if guardian cannot be reached:
Name:______Phone:______
Address:______Relationship:______
Child’s Doctor:______Phone:______
Accidents:
I hereby authorize a representative of The Learning Tree school to obtain and approve medical treatment by a licensed doctor or dentist for the above named child in case of an emergency and parent cannot be reached.
Signature: ______Date: ______
Optional Authorization for Transportation:
I, ______(guardian), hereby authorize The Learning Tree school to provide transportation for my child in a private or public vehicle. Example: Fieldtrips
Authorized to pick up child:
Unless otherwise authorized by you, no one but you or your spouse may pick up your child from The Learning Tree. List below any others you wish to authorize for this purpose.
Give name, address, home & work numbers.
1.______
2.______
Media Release Authorization:
The Learning Tree has created a Facebook page which includes photos of the children. This page was created to give parents the latest information and events. We also want to showcase the children engaged in various activities throughout the day. By signing below you are authorizing The Learning Tree to upload photos of your child to our website and/or Facebook page.
Signature: ______Date: ______
Monthly Payment Amount: ______
Date of Enrollment: ______
Signature of Person Placing Child: ______
Medical Information
Child’s Name: ______
Every child at The Learning Tree must have an updated immunization records form on file.
Please list below any medical, physical or emotional problems which your child has: ______
Any allergies to foods? ______
Are there any foods you do not want your child to have, and if so, what are they? ______
Are there any other mealtime or dietary habits The Learning Tree should be aware of? If so, what are they? ______
Is your child allergic to bee stings? ______
Any bad reaction? ______
Has your child had Tylenol before?______Can it be given? ______
Please list the names and ages of brothers and sisters and other children living at the child’s home: ______
______
Medications: If your child must take medication while at The Learning Tree, it is very important that the staff have the proper instructions. Medications must be handed to a staff member. Please supply the information below: Medications will only be accepted by the provider in their original containers. Please have each medication in a plastic, zip lock bag. Have child’s name, date to begin medication, date to stop medication, times medication is to be given, amount of medication each time, and other directions, if any.
The Learning Tree
Prices Per Month
Full Time / $675.00($156.00 per week)
4 Days / $625.00
3 Days / $575.00
5 (1/2 Days)
Day is 7:30-12:45 or 12:30-6:00 / $575.00
Grade school after school / $280.00
Grade school before school / $130.00
There is a $50.00 registration fee for Preschool and Grade school. The registration fee for Kindergarten is $100.00. The registration fee is non-refundable. After school drop in is $20.00 per day. Drop-in for a full day is $45.00 and a half day is $30.00 per child (5 hours or less), each additional hour is $6.00. If child is not potty trained there is an additional $50.00 charge per month.
New prices effective 1/1/2013
General Rules
One copy to be kept by parent/guardian and one copy to be signed and returned to The Learning Tree.
- Must provide The Learning Tree with a current child’s shot recordstating that they have the required shots corresponding to their age.
- There is a Fall registration fee due by June 1st, and at the time of admission.
- Monthly tuition is due in full on the 1st of every month. A $20 late fee is charged if the payment is made after the 10th of the month. If payment is made on the 1st and 15th of each month a $10 late fee will be charged if over 5 days late.
- A two week vacation is allowed in the summer for year round students only. You do not need to pay for these two weeks if advance notice is given.
- Share day is designated by each room.
- School opens at 7:30 am and closes at 6:00 pm. There is a charge of $1 for every minute before 7:30 and/or after 6:00 for each child.
- Please have your child here before 9:00 am if they are going to be here for the day. If they will not be here or will be late, please contact us by 9:00 am.
- Please do not bring your child to school sick. If they are contagious or have a fever, we cannot take them. If they become sick at school we will have to call you and have you pick them up. Please be advised that your child must be fever free for 24 hours before bringing him/her back to school.
- A two week notice must be given prior to withdrawing from the school.
Parent/Guardian Signature:______Date:______