Enrollment

AGREEMENT FORM Summit Early Learning Center, Inc.

Minneapolis, MN 55405
Phone: 612-377-9011 Fax: 612-977-0168

Child’s Name*
Birth Date*
MM slash DD slash YYYY
Please initial next to the following statements:
I have received the Summit Early Learning Center Parent Handbook
I have been informed of and understand the policies and procedures of SELC:
- Child Illness/Sick child pick-up
- Medications
- Authorized/Emergency pick-up
- Hours of Program operation
- Parent sign in/sign out policy; Arrival and Departure
- Meals/snacks
- Behavior guidelines
- Children’s items/belongings
I have been informed of the goals and overall program of SELC
I am aware that I will be informed of specifics through quarterly newsletters
I agree that it is the responsibility of both the SELC staff and me/we as parents to keep an open line of communication
I understand that all parents will be asked to periodically evaluate the program
I understand that if the tuition payment is late, a late fee will be added to my payment
I understand there is a late fee if I fail to pick up my children by the contracted time
I have provided SELC with all requested information
I have agreed to provide SELC with all updated information, such as phone number, address change, medical records, as soon as possible
Parent/Guardian
Date
MM slash DD slash YYYY
Executive Director
Date
MM slash DD slash YYYY

PERMISSION FORM Summit Early Learning Center, Inc.

Minneapolis, MN 55405
Phone: 612-377-9011 Fax: 612-977-0168

Child’s Name*
Date of Birth*
MM slash DD slash YYYY
Please initial by each activity and sign at the bottom of this form.
I,
“Parent/Guardian Name
grant permission to Summit Early Learning Center for the following:
- My child may go on impromptu walking field trips in the neighborhood (parks/around the pond)
- My child may participate in all center activities while at Summit Early Learning Center, including the use of all play equipment and materials, both indoors and out.
- I DO or DO NOT (circle one) give permission for my child to be photographed in the program, at program functions, and field trips, and for the photographs to be displayed. I understand that the photographs may be taken center staff, professional photographers, news media, or other parents. I understand that I will be notified if any photos are to be used for publicity purposes and I have the right to refuse permission.
- My child may be included in evaluation or research activities approved by the Executive Director.
MEDICAL EMERGENCIES
- I authorize Summit Early Learning Center to take the necessary emergency measures to insure the wellbeing of my child while under supervision of the program, and on my behalf in case of an emergency.
- In case of medical emergencies: I understand that my child will be transported to Hennepin County Medical Center by the local emergency unit for treatment, at my expense, if the local emergency resources (Police, Rescue Squad, etc.) deem necessary.
- In the event of accidental poisoning: I understand that Summit Early Learning Center will contact the Poison Control Center and follow the instructions given by them.
Parent/Guardian
Date
MM slash DD slash YYYY

RIGHT TO TERMINATE Summit Early Learning Center, Inc.

Minneapolis, MN 55405
Phone: 612-377-9011 Fax: 612-977-0168

Child’s Name*
Birth Date*
MM slash DD slash YYYY
Summit Early Learning Center (SELC) reserves the right to terminate childcare.
If a child is totally out of control and/or does not respond to adult intervention, the child’s parents will be notified. It is our policy that if a child is totally out of control and/or walks out of the center without permission, and staff is unable to restrain the child, Minneapolis Police will be called and a report will be made. Parents will be called immediately and asked to come to the center.
We will follow the strike-three guidelines in our program. These guidelines will be used in unresponsive situations.
1. The child will receive a verbal warning regarding any incident that occurs within the center. The parent will be informed of this warning either verbally or written.
2. The second incident will result in a written notice, at which time the parent must come in and discuss the situation with the director and the teacher in order to prevent further incidents.
3. The third incident can result in suspension from the program for 1 to 3 days, or termination, depending on the seriousness of the incident.
4. A fourth incident can result in termination from the program.
We understand misbehavior, however, in order to ensure the safety and wellbeing of all children we must set rules that all children must follow.
All incidents will be reported to parents and will be documented. If an incident is more than two months old, we will place it in the inactive file and start over with the three-strikes policy.
There are times when children may choose to test the limits set up for them. In this process of testing their limits, they may endanger themselves and others around them. This may prompt a call to you, the parent.
It is our policy that any disciplinary actions will be recorded in a classroom log and these actions can be reviewed with the parent at any time.
SELC believes parents and staff must work together to deal with persistent behavior issues such as: fighting, swearing, stealing, or hurting other children or staff members when they occur in the center.
If a child appears to be unusually stressed, anxious, or otherwise motivated to engage in negative behavior, parents will be consulted.
Pleas make sure that you discuss these policies with your child as is age appropriate, so he/she understands what is expected of them.
Parent/Guardian Name
Date
MM slash DD slash YYYY
Executive Director
Date
MM slash DD slash YYYY

CHILDREN’S HEALTH RECORDS Summit Early Learning Center, Inc.

Minneapolis, MN 55405
Phone: 612-377-9011 Fax: 612-977-0168

Child’s Name:*
Birth Date:*
Non-Discrimination Policy
Summit Early Learning Center advertises for children in the public media in order to make openings known and available to all. We welcome and consider all children and their families regardless of race, color, religion, or national origin. We also welcome children with special needs.
Data Privacy
The information you provide during our admission and enrollment process assists the teachers at Summit Early Learning Center (SELC) to best serve your children. The Minnesota Department of Human Services (MNDHS) requires emergency and health information for licensed programs, and Summit Early Learning Center must have this information before your child’s start date. Other information requested is desirable, however may not be legally required. You may refuse to provide SELC information that is not required by law, however, the Executive Director of SELC reserves the right to refuse your child’s service should the omitted information be essential to our program.

The information you provide will be kept in confidence, and will only be made available to the SELC staff who works with your child and staff involved with billing. If your services are subsidized, fully or in part, we are required to allow your funders access to your records. MNDHS may also request access to your records to ensure SELC’s compliance with licensing requirements.
Late Pick-up Policy
SELC provides childcare to you per your contracted hours. The regular day program ends at 5:30pm. Failure to pick up your child(ren) by the scheduled end times and/or your contracted hours will result in a late fee charged: $5.00 per child for every 15 minutes late. On Fridays, the late fee is $10.00 per child for every 15 minutes late. These fees are to be paid when you pick up your child(ren).

I acknowledge I have read and understand the above special policies:
Parent/Guardian
Date

2018 Center Fees	Hourly	Full Day	Weekly
Infant (6 weeks - 15 months)	$21.60	$265.20	$512.40
Toddlers (16 months - 33 months)	$19.20	$230.40	$462.00
Preschool (33 months - 4 1/2 years)	$ 16.80	$195.60	$398.40

Steps to Enrollment

Need child care assistance?

AGREEMENT FORM Summit Early Learning Center, Inc.

Please initial next to the following statements:

ENROLLMENT FORM Summit Early Learning Center, Inc.

Schedule

Parent/Guardian Information

Phone Numbers

Please the option to provide 2 parent/ Guardians.

Parent/Guardian Employment Information

PROGRAM CONTRACT Summit Early Learning Center, Inc.

Parent/Guardian Information

Phone Numbers

Please the option to provide 2 parent/ Guardians.

CONTRACT TIMES

CONTRACT FEES (Office Use Only)

ADDITIONAL FEES(Office Use Only)

EMERGENCY CONTACT FORM Summit Early Learning Center, Inc.

Primary Phone Number Home/Cell/Work

Please the option to provide 2 parent/ Guardians.

Authorized Pick-up Contacts

Emergency Care/Hospital Policy

Physician/Dentist/Health Insurance Information

PERMISSION FORM Summit Early Learning Center, Inc.

Please initial by each activity and sign at the bottom of this form.

RIGHT TO TERMINATE Summit Early Learning Center, Inc.

Summit Early Learning Center (SELC) reserves the right to terminate childcare.

NON-PRESCRIPTION MEDICATIONS CONSENT FORM Summit Early Learning Center, Inc.

In Addition:

MEDICATION LOG

CHILDREN’S HEALTH RECORDS Summit Early Learning Center, Inc.

Non-Discrimination Policy

Data Privacy

Late Pick-up Policy

CHILDREN’S HEALTH RECORDS Summit Early Learning Center, Inc.

HEALTH CARE SUMMARY

IMMUNIZATIONS

INADEQUATELY IMMUNIZED CHILDREN

Health History for Infants and Toddlers Summit Early Learning Center, Inc.

Section A: Health History

Section B: Developmental History

Health History for Infants and Toddlers continued

Section C: Sleeping History

Section D: Feeding History

Section E: Toileting History

Tuition fees