Enrollment Application Step 1 of 22 0% Enrollment Date*(First Day of Attendance)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Legal Guardian #1* First Last Legal Guardian #2 First Last Child's InformationName* First Middle Last Suffix (As it appears on birth certificate)Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Current Age:* Years Months Height (in Inches):*Weight (in Pounds):*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code The Above Child Resides With:* Mother & Father Mother Father Other Name:* Relationship to Child:* Siblings Living at Home with Child:NameAge Click on the "+" symbol to add additional children. Parents' InformationMother's Name:* First Middle Initial Last Address (If Different than Child's) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer:* Profession:* Home Phone:Cell Phone:*Work Phone:Father's Name:* First Middle Initial Last Address (If Different than Child's) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer:* Profession:* Home Phone:Cell Phone:*Work Phone:Contact InformationPlease provide us with ONE current email address and ONE cell phone number per family. By having this information available, we will email and/or text you important updates, documents, newsletters, menus, etc. directly.Parent's Name:* Email:* Phone:* Emergency ContactsIn the event of an emergency situation, the parent(s)/guardian(s) listed on page E-3 will be notified first. In the event that neither parent can be reached at the numbers listed, the parent has authorized Wee Wisdom to contact the individuals listed below in the order in which they are listed.Emergency Contacts:*(You Must List AT LEAST three (3) contacts.)Full Name (First/Middle/Last)Relationship to ChildDaytime PhoneOther Phone Child's Physician(s):*Doctor's NameOffice Address (Address, City, Zip)Office Phone Click on the "+" sign to add additional physician information.Child's Dentist(s):*Doctor's NameOffice Address (Address, City, Zip)Office Phone Click on the "+" sign to add additional physician information.Signature:*Date Submitted:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Authorization of PickupDescription of Agreements*By checking each box, you acknowledge that you have read each statement and agree to these statements: 1. I understand that both parents listed on Enrollment Form (E-3) are assumed authorize to pick up unless notified IN WRITING BY THE CUSTODIAL PARENT. 2. I understand that, if the list below changes, it is my parental responsibility to notify the Wee Wisdom office manager immediately of any deletions and/or additions. 3. I understand that if my child is enrolling in the child care now or at a later date, I must pay a $10.00 deposit for each parent listed on the Endrollment Form (E-3) and each individual listed below on my child's Authorization of Pick Up List. These deposits will be refunded in the form of a credit once I withdraw my child. 4. I understand that, if my child' attends Wee Wisdom Child Care, I must sign a "Key Fob Agreement Policy", which outlines guidelines for securing and/or returning Key Fobs. 5. I understand that everyone, including parents, must enter Wee Wisdom with Picture ID on their person. I understand that it is my parental responsibility to notify all persons listed below of these agreements. 6. I have read and understood all information/policies listed in the parent handbook regarding Wee Wisdom's security system and Key Fob usage. I understand that it is my parental responsibility to notify all individuals listed below of these policies. 7. I understand that my child will not be released to anyone who is not listed below OR anyone who is listed below but cannot verify identify through picture ID and possession of an authorized Key Fob. The following persons have been authorized by me, the custodial parent of the above-stated enrollee, to pick my child up from Wee Wisdom:*NameRelationship to ChildDaytime PhoneOther Phone Click on the "+" icon to add additional people.Signature*Date Submitted:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 About My ChildDevelopment & Behavioral ChecklistChild's Name:* First Middle Last The following checklist is designed to help us get to know your child before his/her start date. Please select those skills your child has already mastered. If your child has not yet completely mastered the skill listed, please do not check the box. Thank you!CommunicationMy Child:* Verbally communicates ALL wants and needs. Occasionally has difficulty verbally communicating wants/needs Does not speak English. Is bi-lingual. In Our Home We Speak:* My Child Speaks the Following Languages:* Eating & DrinkingMy Child:* Can drink from a regular cup without spilling the beverage. Still requires a "sippy cup" when drinking. Uses a spoon and fork independently with eating. Uses a table knife to cut soft foods. Needs assistance with eating/feeding self. Has acquired a variety of tastes and enjoys most foods. Is a picky eater and we are attempting to introduce new foods. Is served a well-balanced diet at home. Has a food allergy and my doctor has provided Wee Wisdom with substitutions to implement while at school/child care. Has a severe food allergy and my child's doctor has provided Wee Wisdom with a written order directing me (the parent) to provide all foods served during the day. I have signed a "Safe Transportation of Food Responsibility Form." My Child's Favorite Foods Are:My Child Does Not Like:Other Information About My Child's Eating & Drinking Habits:Toileting:My Child:* Is totally toilet-trained. Is in the process of toilet-training. Sits down when urinating. Stands up when urinating (boys). Needs assistance removing/unfastening clothing prior to toileting. Needs assistance climbing onto the toilet seat. Needs assistance wiping the following: Needs assistance zipping/buttoning after toileting. At home, my child has good hand washing skills following toileting. At home, we are still working on teaching regular hand washing after toileting. My Child Needs Assistance Wiping:* At Home, My Child Wears During the Day:* Regular Underpants Diapers Pull-Ups At Home, My Child Wears At Nap Time:* Regular Underpants Diapers Pull-Ups At Home, My Child Wears At Night Time:* Regular Underpants Diapers Pull-Ups Other information about my child's toilet habits: Fine-Motor ActivitiesMy Child:* Always holds a crayon/ marker correctly. Needs help in positioning a crayon/marker correctly. Often chooses to engage in coloring. Understands the "concept" of coloring within the lines. Does not understand the concept of coloring within the lines. Is allowed to use safety scissors at home in supervised situations. Has not had experience with cutting paper using scissors. Likes to tear paper. Is beginning to trace and can trace simple lines/shapes successfully. Is beginning to trace letters of the alphabet. Can trace one-digit numbers 0-9. Can copy simple shapes when given a model. Can draw simple shapes without a model. Can trace his/her name. Can copy his/her name when given a model. Can write his/her name independently/correctly without a model. Can write all letters of the alphabet independently without a model. Can draw simple pictures. (ball, happy face, tree, stick-person, house) Can complete a puzzle independently. Can unzip, unsnap, untie, and unbutton articles of clothing. Can zip, snap, tie a knot, and button articles of clothing. Can tie a bow and independently able to tie his/her own shoe laces. Number of Puzzle Pieces:* Gross Motor SkillsMy Child:* Can climb stairs independently using alternating feet. Can descend a stairway independently using alternating feet. Can hop forward using two feet. Can hop backward using two feet. Can hop forward on one foot. Can hop backward on one foot. Can skip correctly. Can throw and kick a ball. Can catch a ball that is rolled to him/her. Can catch a ball in the air that is thrown to him/her. Can run and climb playground equipment. Can pedal a riding toy. Other information about my child's gross motor skills: Resting & NappingMy Child:* Takes regular afternoon naps. Occasionally needs a nap, but is starting to drop regular nap habits. Does not nap at home. Naps with a toy/bear/blanket. Still requires a pacifier at naptime. Requires rocking prior to naptime. Hours Per Day for Naps:* Favorite Toy to Nap With:* Naps Better If: Playing with OthersMy Child:* Is an "only" child, and has not had much exposure to playing with other children his/her own age. Has siblings, but has not had formal experience in playing with others his/her own age. Is an "only" child, but has attended preschool before. Is an "only" child, but has attended preschool before. Needs to develop the concept of "sharing". Needs to develop the concept of "taking turns". Needs to learn to settle conflict with "words" instead of actions. If child becomes frustrated with another child he/she will sometimes: Occasionally, my child has repeated inappropriate language. I have never heard my child use inappropriate language and model good language for our child. Occasionally, my child will hit another child if frustrated. Occasionally, my child has hit an adult out of frustration/anger. Has experienced behavior issues at other Nursery School or Child Care Service. He/She Will Sometimes:* Please DESCRIBE:* Additional Behavior Information:My Child:* My child uses appropriate language at all times. My child will repeat inappropriate language occasionally. My child respects the property of others at all times. Occasionally, my child will mistreat property belonging to others. My child respects the rights of others at all times. Occasionally, my child will disrespect the rights of others. My child interrupts adults when they are speaking. My child interrupts other children when they are speaking. At home, my child is being taught not to interrupt others that are speaking. In our home,our child follows rules and limitations. At home, our child is sometimes disobedient and does not follow rules regularly. At home we correct inappropriate behavior At home, our child as has the following daily responsibilities: At home our child completes the responsibilities willingly. Our child has not yet developed a sense of responsibility Inappropriate Behavior is Corrected By:* Daily Responsibilities Are:* My Number One Concern About My Child's Behavior Is: Please take this time to write down information about your child. Any information that you can provide to us will hopefully help with your child's transition into our Wee Wisdom family!Favorite Toys:*Favorite Foods:*Favorite Books:*Favorite Music:*Name/ Description of Family Pets:*Fears (Storms, Animals, Loud Noises, Ect.):*Additional Information that will assist us in caring for your child.*In addition, please list any concerns that you may have regarding your child's transition into Wee Wisdom.Signature*Date Submitted:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Child's Name:* First Middle Last Parent/Guardian* First Last Intake AgreementAgreement/ Compliance Acknowledgement* I have met with the director, toured the facility, and received a copy of the Parent Handbook of the Link/Password to view the handbook online. The director has answered all of my pre-enrollment questions. I have read the Parent Handbook completely, will refer to it as needed, and will abide by all policies within the Wee Wisdom's Parent Handbook. I have completed and submitted all required enrollment papers and have met all of Wee Wisdom's Enrollment Requirements as indicated in the Parent Handbook. I understand that it is my parental responsibility to notify Wee Wisdom's office manager of any changes to my child's enrollment papers, including contact information and other information pertinent to the every-day care of my child. I understand that, if my child attends Wee Wisdom's Child Care Center, a copy of monthly lesson plans will be placed into my child's wall cubbie on or before the first day of each month. Further, a copy of these monthly plans are posted on each level of the child care center. I understand that a Daily Newsletter will be distributed by each preschool teacher describing the lessons and events that take place each day of Nursery School. It is my parental responsibility to read each newsletter on a daily basis. CONSENT FOR STAFF ACCESS TO HEALTH RECORDS: I give permission for the Wee Wisdom Faculty/Staff to have access to my child's Wee Wisdom Enrollment Forms and Health Records, as the information in my child's file relates directly to the complete and comprehensive daily care of my child. OPERATING HOURS AND SERVICES PROVIDED: I have received a written description of Wee Wisdom's hours of operation and services included in my rates. Further, I also understand that my child will be offered breakfast if he/she arrives prior to 8:00 am daily. ADMISSION, DISCHARGE, ARRIVAL, DEPARTURE POLICIES: I have received a copy of the admission, discharge, arrival, and departure policies. I have read the policies, understand the policies, and will follow the policies. I understand that is my responsibility to make all individuals who are listed under “authorization of pick-up” aware of these policies…including the new policies related to the new security features at Wee Wisdom, including Key Fob policies, cameras, intercom systems, carrying Picture ID into the building daily, etc. WALKING TO AND FROM BUILDING: I understand that I must hold my child's hand when walking to and from the Wee Wisdom Building. Photo Release* I GIVE permission for Wee Wisdom to use my child's picture on paperwork, brochures, parent handbooks, advertisements, and on the Wee Wisdom website. I DO NOT give permission for Wee Wisdom to use my child's picture in any printed material or on the website. State Licensing Law: Public Law 12All licensed Day Care Centers and Nursery Schools have been mandated to the the following in attempt to help state police locate missing/abducted children (Public Law 12, Section 6, IC 12-17.2-2-2-1 (8)* Each parent is to provide Wee Wisdom with a copy of the child's original birth certificate or a "duly attested transcript" of the child's birth certificate. A Wee Wisdom employee can make a copy from the original. Each parent is asked to give consent by signing below, allowing us to include the child's name and birth date pursuant to IC 12-17.2-2-1-5. NOTE: The birth certificate must be submitted on or before the child's first day of attendance. By signing below, I give my permission for Wee Wisdom to report the name and birth date of my child to Division of Family and Children, pursuant to IC 12-17.2-2-1-5.* Prohibited Items at Wee WisdomITEMS PROHIBITED AT WEE WISDOM:*These items include but are not limited to: Any form of hard candy (Examples include lifesavers, jolly ranchers, peppermint candy, gum balls, cinnamon balls, lemon balls, ect.) Round Candy of "ANY TYPE" Un-Inflated Balloons & toys with small parts Peanut M & M's, whole Carrots (Including Baby Carrots), Whole Grapes (Grapes must but cut in half length-wise); Weapons of any type, Toy Weapons of any type (Guns, Knives, Swords, ect.), Pocket Knives Lighters & Matches Coins (School-aged children may keep money/coins in their backpacks only) Hard balls, Rocks, Sticks Taffy Pencils (Sharpened or Unsharpened are prohibited at Wee Wisdom, with the exception of School-aged Children, grades K-6, who will need pencils to complete homework assignments I understand that it is my parental responsibility to enforce these restrictions with my child By signing below, I understand that certain items are prohibited at Wee Wisdom. The above items, which are also listed in my parent handbook, pose a possible health/safety hazard for young children.*Agreement/Compliance AcknowledgementCompliance Agreement*By checking the boxes below, I acknowledge reading each statement & agree to abide by these policies: PHYSICAL EXAMINATION: I understand that my child must have a current physical on file prior to his/her firs day of attendance if my child has allergies or asthma. Further, I understand that the physical exam must be accompanied with an "Action Control Plan" designed/signed/dated by my child's pediatrician/allergy specialist. If my child does not have allergies/asthma, I understand that a current physical must be on file within two weeks of my child's first day of attendance. I understand that the Physical Exam must contain an original signature from the physician who administered the exam. A current physical is defined as having taken place not more than twelve (12) months prior to the child's first day day of attendence or within two (2) weeks of the child's first day of attendance. Failure to provide this required record will result in delayed enrollment or interruption of attendance. IMMUNIZATION RECORDS: I have a copy of Wee Wisdom's Immunization Requirements, which are listed in my Parent Handbook. I understand the requirements. I understand that I must provide Wee Wisdom with a complete list of immunizations that my child have been given. Further, I understand that the immunizations must be "current" and in direct compliance with the State of Indiana pursuant to Licensed Child Care Centers. I understand that my child's immunizations must be current and provided to Wisdom on or before my child's first day of attendance. If my child is missing one or more immunizations, I must do one or more of the following prior to my child attending: Make an appointment with my child's doctor to bring immunizations to current status. Then, bring Wee Wisdom a copy of immunizations that have been given during this appointment. Secure an exemption from my child's doctor stating the reason why the immunizations are not current, the plan to make them current, and a statement from the doctor verifying the following: A. The child who is enrolling will not be at risk by attending without the minimum immunizations. B. The child who is enrolling will not put other children already attending at risk by enrolling without the required minimum of immunizations. The parent/guardian may submit a written statement indicating that immunizations are in contradiction with parental religious beliefs and/or personal beliefs. (NOTE: If a parent has religious objections to immunizations, the parent must still provide Wee Wisdom with a Doctor's written exemption containing the two statements (A and B) listed above.) These statements from parents and the physician are due prior to the child's first day of attendance. BIRTH CERTIFICATES: I understand that I must provide Wee Wisdom Nursery School and Child Care Center with an authentic copy of my child's birth certificate. I understand that this requirement is state-mandated for all licensed day care centers. I understand that this document must be on file prior to the first day of my child's attendance. DISCIPLINE POLICY: I have received a copy of Wee Wisdom's Discipline Policy, which is contained within the Parent Handbook. I have read and understood the policy. I believe that my child's behavioral needs can be met through the implementation of this policy. Further, I understand that it is my parental responsibility to reinforce appropriate behavior at home in attempt to maintain consistency between home and school. MEDICATION POLICY AND SICK CHILD POLICY: I have received a copy of Wee Wisdom's medication policy and Wee Wisdom's sick child policy, which are both contained within my Wee Wisdom Parent Handbook. I have read the policies, understood the content of both policies, and will abide by the policies. Further, I understand that I will be notified of any additional circumstances that apply to my child, including exposure to communicable illness, suspected illness of my child, and/or accidents that have occurred resulting in first aid treatment of my child during the day. RESTING/NAPPING POLICIES: I have received a copy of Wee Wisdom's resting/napping policy. I have read and understand the policy. I will abide by the content of the policy. CHANGE OF CLOTHING: I have read Wee Wisdom's policy regarding providing a change of clothing that is seasonally appropriate for my child AT ALL TIMES. I UNDERSTAND AND WILL ABIDE BY THIS POLICY. Agreement/Compliance Acknowledgement (Continued)Compliance Agreement:*By checking the boxes below, I acknowledge reading each statement & agree to abide by these policies: NAPPING ARTICLES: I have read Wee Wisdom's requirement for napping articles that I, as the parent, must supply. I understand that a sleeping bag and pillow OR blanket and pillow are to be brought to Wee Wisdom at the beginning of each week clean and laundered from the previous week. I understand that these personal articles must be labeled with my child's first and last name, must be taken home at the end of each week, laundered, and returned on Mondayy of each week. I understand that if I forget to bring bedding for my child, I will be contacted at home or at work to return to Wee Wisdom with the necessary bedding prior to naptime on any given day. HIRING WEE WISDOM STAFF FOR PRIVATE BABY SITTING SERVICES: Wee Wisdom does not endorse employees during private baby-sitting for Wee Wisdom students. If you choose to employ a Wee Wisdom staff person to do private baby-sitting outside of the Wee Wisdom setting, Wee Wisdom is not responsible for any liability connected with the care that takes place during this private arrangement. PARENT-TEACHER CONFERENCES: I understand that minimum of two (2) Parent- Teacher conferences will be held annually. I understand that parent attendence is manditory at both conferences. If both parents do not reside in the same home, it is the custodial parent's responsibility to makesure the non-custodial parent is notified of the conference date and time so the BOTH PARENTS CAN ATTEND. Wee Wisdom will be happy to arrange for two separate conferences if necessary. Additional conferences may be scheduled at any time upon request fro the teacher, parent, or student. TRANSPORTATION PERMISSION: My child is in Grades K-6 and attends one of the following schools during the school year: St. Mary's, Burris, Storer, or Westview. I understand that Wee Wisdom will provide transportation to and/or from my child's school if my child is enrolled to attend after school child care. Transportation services may be denied due to lack of seating vacancies in the Wee Wisdom vehicle. I understand that there is an additional fee for transportation services. I have received a fee schedule for transportation, and a written policy of Transportation Services provided by Wee Wisdom. I understand that it is my responsibility to notify Wee Wisdom if my child is absent and will not require transportation on his/her regular schedule. NON-NOTIFICATION FEE: I have received, read, and understood Wee Wisdom's Policy regarding the Non-Notification of Transportation Needs. I understand that notification must take place by a certain time daily. I understand that I will be assessed a fee if I fail to notify Wee Wisdom prior to the time indicated on the policy. Further, I understand that my child's transportation services may be terminated if I fail to notify Wee Wisdom of transportation changes prior to the deadline indicated within the parent handbook. PERSON LEGALLY RESPONSIBLE FOR CENTER: I understand that Denise Allen, as owner and director of Wee Wisdom Nursery School and Child Care Center, Inc., is legally responsible for the Center. CHILD ABUSE/NEGLECT POLICY: I have received/read/understand Wee Wisdom's policy for reporting child abuse and neglect. POLICY REGARDING RELEASE OF A CHILD TO AN INTOXICATED OR IMPAIRED PERSON: I have received/read/understand Wee Wisdom's policy for non-release to a person who appears to be intoxicated and/or impaired. POLICY REGARDING CHILDREN LEFT PAST CLOSING TIME: I have received/read/understand Wee Wisdom's policy regarding children left past closing time. I understand that late pick-up fees will be attached to my balance based on the late fee policy's listed in my parent handbook. Further, I understand, that, in the event of late pick up past 6:30 pm., (and neither parent or emergency contacts can be notified by numbers provided by parents), child protective services will be called. INCLUSION POLICY: I have received/read/understand Wee Wisdom's inclusion policy. I understand that Wee Wisdom has the right to refuse admission if reasonable adjustments to our current program will not meet the existing needs of any student. PROHIBITION POLICY: I understand that Wee Wisdom STRICTLY PROHIBITS smoking on Wee Wisdom "property", the use of possession of alcohol or other illegal substances on Wee Wisdom "property", and/or the possession of firearms on Wee Wisdom property. I understand that "property" is defined as in the building and/or grounds (including the parking lots, side street parallel to pool, riding court, pool area, and play ground areas). CONFIDENTIALITY POLICY: I have received/read/understand Wee Wisdom's Confidentiality Policy. COLLECTION OF UNPAID BALANCES: I agree, that in the event of default in payment , reasonable collection agency fees equal to fifty percent (50%) of the delinquent balance, as well as, attorney fees for Wee Wisdom court costs plus my court costs and my attorney fees, will be added to the amount due on the account. VACATION WEEKS: I understand that I may take unlimited vacation weeks in both Nursery School and Child Care. However, I will be responsible for paying for absences according to absent-fee rates listed in my parent handbook. Further, I understand that Nursery School is NEVER discounted for absences. I also understand that any fees that will be incurred during my child's absence MUST BE PAID IN ADVANCE OF THE ABSENCE. LATE FEES: I have received/read/understand Wee Wisdom's policies regarding late payments. (Revised 06/01/15) I understand that late payment fees will automatically be generated to my account if my payments are not received by the due date. Agreement/Compliance Acknowledgement (Continued)Compliance Agreement*By checking the boxes below, I acknowledge reading each statement & agree to abide by these policies: NON SUFFICIENT FUNDS (NSF) FEE: I have received/read/understand Wee Wisdom's Policy regarding returned checks due to 'Non-Sufficient Funds'. Further, I understand that if I write more than one check that is returned due to NSF, Wee Wisdom will require all additional payments to be in the form of a money order. TAX STATEMENT PREPARATION: I have received/read/understand that Wee Wisdom will preparean annual tax statement for all parents who use our child care center. I understand that I must call the office manager and request a tax statement within one (1) week prior to the day I will need to pick it up. EXTRACURRICULAR ACTIVITIES SPONSORED BY WEE WISDOM: I understand that Wee Wisdom organizes several "extracurricular activies" through the year. I understand that participation in these activies require written parental permission. I understand that specfic information on dates/times/description of the activity and participation fees will be provided to me throughout the year. NURSERY SCHOOL AREA: I give permission to my child to participate in activities in the Nursery School area of the building, not to exceed four (4) hours per day. I understand that ratios will be followed at all times. Further, I understand that, because children do not participate in activities in the Nursery School are for over four hours in any given day, the State of Indianawill not license the Nursery School portion of the building. However, the MWF and Pre-K Nursery School Programs are accredited because they meet for over two (2) hours per day. NURSERY SCHOOL IN-CLASS PARTIES: I understand that I must be present or have an adult/parent designee present for the following Nursery School events: Halloween Party, Easter Party/Treasure Hunt, Big Wheel Race, and Family Picnic. I understand the dates/times will be listed in my annual school year calendar. SUNSCREEN PERMISSION: I give permission for Wee Wisdom staff to apply sunscreen twice daily for my child during the months of June, July, and August. I understand that I must provide the sunscreen, which I will pre-label with my child's first and last name (water-proof, permanent markers only) and submit to Wee Wisdom prior to the first day of swimming. I understand that the sunscreen will be kept out of reach of all children and will be applied only by the staff of Wee Wisdom. I understand that the sunscreen must remain at Wee Wisdom through the summer and is not to be taken home daily or taken home on weekends. Further, I understand that sunscreen bottles/tubes may not be shared between siblings. In addition, I understand that I may request more than two applications per day if deemed necessary to prevent sunburn. ADDITIONAL FEES ASSOCIATED WITH NURSERY SCHOOL ENROLLES/CHILD CARE ENROLLEES: I have received a copy of additional fees associated with Nursery School and/or Child Care. I agree to provide what is necessary for my child in both Nursery School and Child Care. PAYMENT POLICY: I understand that Wee Wisdom accepts CHECKS OR MONEY ORDERS ONLY...NO CASH PAYMENTS ARE EXCEPTED. WEE WISDOM PARENT HANDBOOK: I understand that I am responsible for reading/understanding/following all rules, regulations/policies listed in the parent handbook, which was either given to me at the initial intake meeting or provided to me through Wee Wisdom's online access link. I understand that I may seek additional interpretation from Mrs. Allen at any time, should any of this information be unclear o require additional explanation for my comfort level of interpretation. Pool UseI, PARENT OF THE ABOVE LISTED ENROLLEE, give permission for my child to participate in the Summer Swim Party Programs at Wee Wisdom. I understand that the pool is 8 feet deep in the deepest part. I understand all policies connected with summer swim, including floatation devices required for non-swimmers, which must be purchased annually and submitted to Wee Wisdom prior to the first day of swim. I understand that floatation devices are to remain at Wee Wisdom until one or two things occur:* My child passes the swim test administered by one or more of Wee Wisdom licensed life guards. or The summer ends and the pool closes, at which time I may take the floatation devices home. I understand that, if I choose to use water wings as floatation for my child, my child must be age 3 or older and that water wings must be "pre-inflated". I, PARENT/GUARDIAN OF THE ABOVE-LISTED ENROLLEE, understand:* that I may observe my child's group swim sessions and/or swim lessons from inside the Nursery School Multi-Purpose Room that at NO TIME, are children to be on the deck or stairway to the deck. However, parents may opt to watch group swim or swim lessons from the deck area... PROVIDED NO CHILDREN ARE WITH THE ADULT WATCHING THE LESSON. THE DECK IS OFF-LIMITS AT ALL TIMES TO CHILDREN. that parents are not permitted to enter the pool area at any time that contact with lifeguards is not permitted while the pool is in operation that I can leave a message via the main office if I wish to speak with a lifeguard, at which time the lifeguard will return my call at the earliest time once off duty for the day LIFEGUARDS ARE NOT TO BE DISTRACTED AT ANY TIME FOR ANY REASON WHILE IN THE POOL AREA SUPERVISING CHILDREN. By signing below, I agree to the above statements:*TOILET TRAINING(Sign here only if the above enrollee is not currently toilet-trained)I give permission for Wee Wisdom to begin the toilet training process when I, as the custodial parent, and the Wee Wisdom staff deem that this process is developmentally appropriate.Date Submitted:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Parent Volunteer FormChild's Name:* First Middle Last Parent Sign-UpHalloween Party (October)*Please check all that apply. I am willing to serve as a Chairperson I am willing to serve as a Committee Member Easter Party/Treasure Hunt (Spring)*Please check all that apply. I am willing to serve as a Chairperson I am willing to serve as a Committee Member Thank you for volunteering to help with our parties! Your participation will help make our parties special! Your time and efforts are very much appreciated!Signature*Date Submitted:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Special Dietary Needs/RequirementsChild's Name* First Middle Last Special Dietary Needs/Requirments* My child does not have special dietary needs/requirements. Please sign and date the bottom of this page. My child DOES have special dietary needs/requirements based on medical reasons as described below: (PLEASE NOT: IN ADDITION TO A PARENT DESCRIPTION OF THE MEDICAL ISSUE BELOW, THE PARENT MUST ALSO PROVIDE A STATEMENT FROM THE DOCTOR, COMPLETE WITH A LIST OF SUBSTITUTIONS THAT ARE APPROPRIATE FROM THE DOCTOR'S STANDPOINT.) My child does have special dietary needs/requirements, based upon our family's religious or personal beliefs. Special Dietary Needs Acknowledgement:* I have read Wee Wisdom's policies and "Special dietary needs", food allergies, physical examination requirements, "special needs enrollees", and "inclusion policies". I have discussed these policies with my child's physician, and my child's physician agrees with me that Wee Wisdom's environment and methods of intervention related to my child's dietary needs will be "medically safe and free from potentially hazardous risks." NOTE: If a food allergy is present, Wee Wisdom reserves the right to request that parents furnish all foods for their child(ren). If this applies, please read/sign below. Parents Description of Special Dietary Needs:*Parents Suggestions For Providing Substitutions:*Description of special dietary needs/requirements based upon religious or personal beliefs:*NOTE: If a food allergy is present, Wee Wisdom reserves the right to request that parents furnish all foods for their child(ren). If this applies, please read/sign below.Food Transportation AgreementSAFE TRANSPORTATION OF FOOD RESPONSIBILITY Food must be brought to the center in clean, insulated, and sanitized containers, which keeps cold food at 41 degrees F., or below and hot food at 135 degrees F., or above. Upon receiving the food fro the parent, the center shall verify the temperature of the food. When potentially hazardous food temperature is not correct, the center WILL NOT ACCEPT THE FOOD.Due to medical reasons documented and attached from my child's physician, I, parent of the student listed at the top of this page, will provide food for my child on a daily basis. As the parents, I take full responsibility for the safety of food preparation, the selection of the food, the storage and transport of the food to Wee Wisdom. Since I am providing food for my child to eat each day, I assume full responsibility for the nutritional needs of my child. Full Parent Name:* Signature*Date Submitted:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Child's Name:* First Middle Last Are you wanting to register for Nursery School?* Yes No Nursery School SelectionI would like my child registered for:* Friday Toddler Class - 9:00 -10:25 am T/TH Classes - 8:30 -10:20 am T/TH Classes - 10:30 -12:20 pm M/W/F Classes - 8:30 -11:20 am M/W/F Classes - 12:30 -3:20 pm Pre-K Classes - 8:00 -10:55 am Pre-K Classes - 12:00- 2:55 pm Child's Name:* First Middle Last Are you wanting to register for Child Care?* Yes No Child Care Choice: August-MayI would like my child under the following child care choice:*(August-May) #1 Weekly #2 Daily #3 Half-Day #4 After School #5 Before School #6 Social Hour Which day(s) of the week will your child be attending?*Check all that apply Monday Tuesday Wednesday Thursday Friday What time will your child be staying with us?*Please list in a four (4) hour block. For example: Monday 11a-3p.Day of WeekHours One Child, August - May* 2 year old 3, 4, 5 year olds Do you need summer child care?* Yes No Child Care: SummerI would like my child under the following child care choice:*(Summer) #1 Weekly #2 Daily #3 Half-Day #6 Social Hour Which day(s) of the week will your child be attending?*Check all that apply Monday Tuesday Wednesday Thursday Friday What time will your child be staying with us?*Please list in a four (4) hour block. For example: Monday 11a-3p.Day of WeekHours One Child, June-July (Summer)* 2 year old 3, 4, 5 year olds Transportation Needs K-6Child's Name:* First Middle Last Transportation Needs:* My child will not require Wee Wisdom transportation either to or from school. My child will require Wee Wisdom transportation as listed: To School:Name of School From School:Name of School Payment OptionsIf your child attends nursery school exclusively, payments are due monthly on the first of each month. If your child attends nursery school and child care, you have three options for payment: Weekly: Payment due on or before Friday of each week or the last day child is scheduled to attend each week. Bi-Weekly: Payment due on or before Friday of each week or the last day child is scheduled to attend each week. You must pay 1 week in arrears and 1 week in advance. Monthly: You will be billed the third week of every month for the upcoming month Payments due on or before the 1st of each month in advance of services.My child is enrolled in:* Nursery School Only Nursery School/ Child Care Combination Child Card Only (School Age K-6 & Summer CC) I would like my payment options to be:* Weekly Bi-Weekly Monthly My payment options is:* Monthly Security System Agreement: Use of Key FOBSStudent Name:* First Middle Last Description of Agreement*Please read each item and select box to indicate that you understand and will abide by these rules. 1. I understand that each person listed on my child's authorization of pick up list much have their own key fob at all times when arriving to drop off and pick up. 2. Sharing Key Fobs among authorized/unauthorized users is not permitted. 3. No one will be permitted to enter the building without an authorized Key Fob or prior approval from the office, which will require picture ID. 4. Authorized users may still be required to show picture ID upon arrival to pick up children. If we do not recognize someone entering our building, even if they possess a key fob, picture ID will still be required. 5. Only individuals listed on your authorization of pick up list will be permitted to leave the building with your child. If you need to add or delete individuals from this list at any time, it is the parent's responsibility to keep the list current with the main office. 6. If you delete someone from your authorization list, you must return the key fob assigned to that individual immediately to avoid a lost or stolen key fob fee of 25.00. Upon the timely return of the Key Fob, you will be given a credit of 10.00 for each key fob returned. 7. If you need to add someone to your authorization list, you must come to the office and meet Kathy. She will give you an additional key fob upon receipt of your 10.00 deposit. The new key fob will be assigned by number to the new person that you have added. 8. Upon entering the vestibule, you must wait for anyone who is attempting to enter to complete their entry and for the door to close again. DO NOT ATTEMPT TO ENTER WITHOUT USING YOUR OWN KEY FOB AND WAITING FOR THE DOOR TO OPEN IN RESPONSE TO YOUR "ENTRY". (IE., DON'T PIGGY- BACK INSIDE ON SOMEONE ELSE'S ENTRY) 9. Keep you Key Fob on your Key Ring. When entering the vestibule, touch the reader with the fob. It will read your number, and the door will automatically unlock for you to enter. 10. If you need to add someone to your authorization list as an emergency, call the office in advance to announce that you are sending someone that is not on your list. You will automatically be assessed an additions $10.00 fee for an additional key fob. It is your responsibility to inform all authorized persons (even those that you may add in an emergency situation) that they must always bring their picture id into the vestibule with them. Anyone who attempts to enter must show their picture ID to the camera in the vestibule. We will check the id from the office over the screen and based on our advance knowledge of that person's arrival, we will unlock the door and allow them to enter. 11. If you lose a key fob, you will be charged an additional fee of 25.00 and you will also lose your down-payment of 10.00 for each key fob not returned or each key fob reported as lost or stolen. In addition, you will need to pay another $10.00 deposit on any new key fob issued. 12. When you withdraw from Wee Wisdom, your account will be credited 10.00 for each key fob that you return on or before the last day of attendance. 13. Wee Wisdom will be on "lock-down" all day every day. 14. I understand that if addendum's are made to this agreement, parents will receive a copy of these changes in writing. 15. Key Fobs are issued and returned only through the main office administration. Signature:*Date Submitted:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Insurance InformationStudent's Name:* First Middle Last Suffix Date of Birth:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Insurance Coverage:*CURRENT INFORMATION ABOUT YOUR CHILD'S HEALTH INSURANCE COVERAGE IS REQUIRED FOR TREATMENT IN AN EMERGENCY: My child DOES HAVE insurance coverage at this time My child DOES NOT HAVE insurance coverage at this time. My child is covered by Medicaid. Insurance Carrier: (Company)* Policy Number:* Name of Insured:*(Example: If the policy is carried by the father, list the father's full name." First Last Relationship to above student:* In the case of a medical or dental emergency, Wee Wisdom has identified IU Health/Ball Memorial Hospital as the "facility of intent" for emergency services that may be needed. On Enrollment Form E-4, the parents/guardians of all enrollees have signed consent for emergency treatment and trasnsport to IU Health Ball Memorial Hospital IF NEEDED. This form has been notarized and is on file to use in the event of an emergency that requires immediate medical or dental attention. INDIVIDUAL EMERGENCY CARE PLAN FOR THE ABOVE STUDENT:Please list and describe any known medical or developmental problem or other conditions that might require special care in an emergency. [Examples include, but are not limited to: Allergies (environmental, food, medication, other); Asthma, Seizures; Orthopedic or Sensory Problems; and other Chronic Conditions, including conditions that require regular medication or technology support.] Family AlbumHello! My Name is:* First Middle Last Suffix I live with:* I have pets at my house. They are:*In my house, we speak the following language(s): My family is from: United States of America (USA) My family and I like the following foods:Our favorite holidays and celebrations are:(Please describe.)Some of our family customs include:(Please describe.) Family Pictures & DescriptionsPlease upload pictures that your child can share with the class. Pictures may include family members, pets, family vacations, customs, celebrations, etc.Photo #1Max. file size: 32 MB.Please write a description for photo #1.Photo #2Max. file size: 32 MB.Please write a description for photo #2.Photo #3Max. file size: 32 MB.Please write a description for photo #3.Photo #4Max. file size: 32 MB.Please write a description for photo #4.
