HGBCCHILDHOODLEARNINGCENTER 4001 Custer Road Plano, TX75023 (972) 519-0365

2014-2015 ENROLLMENT AND STUDENT INFORMATION FORMS

Date of Enrollment _____/_____/_____ Child’s Date of Birth ____/____/____  □Boy □Girl

Child’s Legal Name ______

Last First Middle Initial Name Child Goes By

Address ______

No. & Street Apt. City Zip Code Home Phone No.

What language does family speakmost of the time at home?______

Family E-Mail Address
Important for HGBC-CLC communication

PLEASE FURNISH THE FOLLOWING INFORMATION IN CASE OF ACCIDENT / SUDDEN ILLNESS

Mother Lives with Mother□ / Father Lives with Father□ / Step-Parent/Guardian Lives with□
Name / Name / Name
Employer / Employer / Employer
Occupation / Occupation / Occupation
Work Phone ( ) / Work Phone ( ) / Work Phone ( )
Cell Phone ( ) / Cell Phone ( ) / Cell Phone ( )
Home Address ( if not same as student’s) / Home Address ( if not same as student’s) / Home Address ( if not same as student’s)
Doctor / Address / Phone

Physician Information

Doctor / Address / Phone

Hospital Information

List at least two people other than parents who may assume responsibility of child from CLC atdismissal or in the event of an emergency. CLC cannot release child to anyone not on list. Please make sure you give us daytime phone numbers.

Name(s) / Address and Phone Number / Relationship

EMERGENCY MEDICAL AUTHORIZATION Notary Services Available at CLC Office

In the event that child’s parents, other persons named above, or named physician cannot be reached at the time of illnessor accident; or if emergency is such that time does not permit such contact, I authorizeHGBC CHILDHOOD LEARNING CENTER to take aforesaid child to the nearest clinic or hospital for any and all necessary emergency medical care.

______

Mother/Father/Guardian Signature

State of Texas, County of ______

Before me, the undersigned authority, on this day appeared ______known to me to be the personwhose name is subscribed above, and acknowledged to me thathe/she executed the same for the purpose therein expressed.

Sworn and subscribed before me this______day of ______, 20_____.

Notary Signature______

PERMISSION TO PHOTOGRAPH

The undersigned gives permission to the Childhood Learning Center of Hunters Glen Baptist Church to photograph his/her child and use the resulting photographs for any purpose that

HGBC-CLC deems proper.

______

Signature of Parent or Guardian Date

Discipline and Guidance Policy for HGBC Childhood Learning Center

Discipline must be:

(1)Individualized and consistent for each child;

(2)Appropriate to the child’s level of understanding; and

(3)Directed toward teaching the child acceptable behavior and self-control.

A caregiver may only use positive methods of discipline and guidance that encourage self-esteem, self-control, and self-direction, which include at least the following:

(1)Using praise and encouragement of good behavior instead of focusing only upon unacceptable behavior;

(2)Reminding a child of behavior expectations daily by using clear, positive statements;

(3)Redirecting behavior using positive statements; and

(4)Using brief supervised separation or time out from the group, when appropriate for the child’s age and development, which is limited to no more than one minute per year of the child’s age.

There must be no harsh, cruel, or unusual treatment of any child. The following types of discipline and guidanceare prohibited:

(1)Corporal punishment or threats of corporal punishment;

(2)Punishment associated with food, naps, or toilet training;

(3)Pinching, shaking, or biting a child;

(4)Hitting a child with a hand or instrument;

(5)Putting anything in or on a child’s mouth;

(6)Humiliating, ridiculing, rejecting, or yelling at a child;

(7)Subjecting a child to harsh, abusive, or profane language;

(8)Placing a child in a locked or dark room, bathroom, or closet with the door closed; and

(9)Requiring a child to remain silent or inactive for inappropriately long periods of time for the child’s age.

My signature verifies I have read and received a copy of this discipline and guidance policy.
______
Signature of Parent or Guardian Date

Texas Administrative Code, Title 40, Chapters746 and 747, Subchapters L, Discipline and Guidance

CLC - CHILD INFORMATION SHEET FOR TEACHER

Name of Child ______DOB ___/___/___ □Boy □Girl

Parent’s Names ______

Daytime Phone Number(s) ______

Names of Child’s Brothers/Sisters M/F Age

______

______

______

______

Are parent(s) single, married, separated or divorced? ______
Will this be child’s first “real separation” from mother? ______Has child previously been enrolled
in child care or nursery school? ______If so, where? ______
Was it a pleasant experience? ______
Does child attend Sunday School? ______Where? ______
What church/temple/synagogue does mother attend? ______
What church/temple/synagogue does father attend? ______

Circle any diseases your child has had: Chicken Pox Diphtheria German Measles

Polio Rheumatic Fever Whooping Cough Mumps

Other Diseases (specify)

Circle surgeries your child has had: Tonsillectomy Adenoidectomy Appendectomy

Other Surgeries (specify)

Does your child have any distinguishing BIRTHMARKS?

List any Allergies your child has
Will you be furnishing emergency medication for your child to be kept at school?

Child’s pets and names ______

Child’sfavoritetoys,games,activities______Does your child cry easily? ______If so, how do you handle this? ______What fears, if any, does your child have? ______How do you handle these fears? ______

Does your child haveany “behavior problems”? ______Ifyes, please describe how they are handled at home

______Does your child have any “nervous habits” such as thumb sucking or nail biting? ______How are these habits managed at home? ______

Does your child self-feed completely? ______Please note any eating problems and how they are managed

Child’s Bedtime ______Wake Up Time ______Nap Time ______

Sleep problems, if any______

Your child’s term for: Urination ______Bowel movement ______

What particular time of day are child’s bowel movements? ______

Does your child wet or soil his/her bed? ______Daytime clothes? ______

Please list any additional information you think teachers need to know about your child
What expectations do you have for your child this school year?

Hunters Glen Baptist Church

CHILDHOODLEARNINGCENTER

4001 Custer Road Plano, TX75023 (972) 519-0365

MEDICAL FORM FAX # (972) 519-8336

Child’s Name Date of Birth

HEALTH INFORMATION & HISTORY (to be completed by physician’s office)

Allergies ______

Existing Illness ______

Previous Illness ______

Physical or Mental Impairment ______

Special Needs ______

Before your child attends classes at Hunters Glen Baptist Church Childhood Learning Center, you must present a current immunization record and a statement of good health from the child’s physician.

Physician’s office may either complete and sign chart below or attach a machine copy of

current immunization record signed or stamped by physician.

IMMUNIZATIONS

DTaP / Hib / Polio / MMR / HepB / HepA / Varicella / Pneumo / Roto / Mening

TB Test (if required) ______Positive______Negative______Date

PHYSICIAN’S STATEMENT

I have examined the above-named child within the past year and find that he/she is physically able to take part in the preschool program at Hunters Glen Baptist Church Childhood Learning Center.

______

Physician Signature Date

Parent Involvement Form2014 - 2015

Parent Name Cell Phone

Email

Teacher Appreciation Committee – Provide special snacks/meals or CLC staff and help with Staff Appreciation Events.

______Yes, I would like more information______No

Room Mom – Help with planning and implementing class parties

______Yes, I would like more information______No

Special Events: Place a check next to any of the events you would like to help with below.

______Hospitality Bakers – Bake 3-4 doz cookies for special events

______Readers – Read in the classroom to the children at a specified time

______Office Help

______Individual and Class Picture Day Helper – Assisting the photographer on picture day

______Texas Days – Help man a booth

______Class Basket Coordinator for our Spring Fling and Silent Auction

______Fundraiser Assistant – if the school does a fundraiser in the fall

______Ministry Project Coordinator – help coordinate and organize ministry projects that

Serve the community

______Other :

If you checked “yes” to any of the items above, someone will contact you.

Parent Handbook Statement

I have read the Parent Handbook and will abide by the policies and procedures outlined therein. I understand that CLC is a Gang Free Zone and have been notified as such.

Parent SignatureDate

Health /Illness Statement

I have read and understand the health policies as stated in the Parent Handbook. I agree to the health polices as laid out in the Parent Handbook.

I understand that HGBC-CLC may find it necessary to modify the illness policies during flu or other similar related outbreaks.

______

Parent SignatureDate