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Student Enrollment Packet
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Student Information
Child's Full Name
*
First
Middle
Last
Goes by
*
Address
*
Street Address
City
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Tennessee
Texas
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Vermont
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West Virginia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date of Birth
*
MM slash DD slash YYYY
Gender
*
Please select:
Male
Female
Sibling Enrolled
*
Please select:
Yes
No
If Yes, Sibling Name and Age
Parent Information
Mom's/Legal Guardian #1 Name
*
First
Last
Mom's/Legal Guardian #1 Cell Phone Number
*
Mom's/Legal Guardian #1 Work Phone Number
Mom's/Legal Guardian #1 Email Address
*
Dad's/Legal Guardian #2 Name
First
Last
Dad's/Legal Guardian #2 Cell Phone Number
Dad's/Legal Guardian #2 Work Phone Number
Dad's/Legal Guardian #2 Email Address
Emergency Care Information
Name of Child's Pediatrician
*
Pediatrician's Phone Number
*
Hospital Preference
*
Name of Insurance Plan
*
ID#
*
Subscriber's Name (on insurance card)
*
First
Last
Parent/Legal Guardian Consent and Agreement for Emergencies
As parent/legal guardian, I give consent to have my child receive first aid by facility staff, and if necessary, be transported to receive emergency care. I understand that I will be responsible for all charges not covered by insurance. I give consent for an emergency contact person listed on this form to act on my behalf until I am available. I agree to review and update this information whenever a change occurs.
Parent's/Legal Guardian’s Signature
*
Date
*
MM slash DD slash YYYY
Medical History
Is your child allergic to anything? (Y/N) If Yes, please describe.*
*
*For confirmed allergies, please complete the Allergy Alert Form and Action Plan - available on the preschool website.
Does your child have any special conditions or medical issues to be aware of? (Y/N) If Yes, please describe.*
*
*For special conditions or medical issues, please complete the Special Care Plan - available on the preschool website.
Required Forms - upload online, no paper copies accepted: 1. Annual Medical Form signed by a physician - due by the 30th day of school for child to maintain enrollment at TCC. 2. Current Immunization Record - due by the 30th day of school for child to maintain enrollment at TCC.
Emergency Contacts
To whom child may be released if legal guardian is unavailable
Emergency Contact #1 Name
*
First
Last
Emergency Contact #1 Phone
*
Emergency Contact #1 Relationship
*
Emergency Contact #2 Name
*
First
Last
Emergency Contact #2 Phone
*
Emergency Contact #2 Relationship
*
Emergency Contact #3 Name
First
Last
Emergency Contact #3 Phone
Emergency Contact #3 Relationship
Permissions
TCC Directory
*
The Children's Circle Directory, distributed to each family in the fall, is for school family use and may not be reproduced without permission. For the Directory, please select ONE of the two options below:
Please choose one:
I give The Children’s Circle permission to print child’s name, mom’s name, dad’s name, family address, mother’s cell and family's primary email address in The Children’s Circle Directory.
I give The Children’s Circle permission to print only child’s name, mom’s name and dad’s name.
Photography
I do hereby grant the unlimited right to use and/or reproduce photographs,* likenesses or the voice of my child in any legal manner and for the internal or external promotional and informational activities of The Children’s Circle at Myers Park United Methodist Church. I further understand that by signing this release, I waive any and all present, or future compensation rights to the use of the above stated material(s).
I agree to the Photography policy.
Procare Solutions - Classroom Communication Tool
*
I give my child's teachers permission to use my information to provide access to Procare Solutions, which will be maintained by his or her teachers. Procare Solutions is password protected and only for the parents in my child's classroom. This account/app will serve as a communication tool between the teachers and the parents and will include classroom updates and photos of the children engaged in activities and events.
I agree to the Procare Solutions consent.
Class Email List
*
I give my child's teachers permission to share my email address with the other families in the classroom. My email address will only be used for the purpose of classroom communications.
I agree to the Class Email List consent.
Parent/Legal Guardian Name
*
First
Last
Parent/Legal Guardian Signature
*
Date
*
MM slash DD slash YYYY
Potty Training Policies Agreement
Potty Training Policy
*
Children in our Toddlers and Twos program are NOT expected to be potty trained. We ask that parents provide disposable diapers as well a complete change of clothes that will remain in your child’s cubby at school. If your child begins the potty training process while in our Toddlers or Twos program, we will partner with you to help with this process within the confines of our busy preschool day.
Children enrolled in our 3s, 4s and TK program MUST BE potty trained in order to attend. Children must be wearing underwear and very rarely having accidents. Please note that wearing pull-ups isn’t considered being potty trained.
Why do 3s, 4s and TK have to be potty trained?
• There are strict standards for changing and disposing of wet or soiled diapers.
• The classrooms are not equipped for diaper changing.
• When an adult is busy changing a child’s diaper or soiled clothing, it is taking away from learning time for all students and it removes one adult from the direct supervision of and interaction with the rest of the class.
A potty-trained child is a child who can do the following:
1. Communicate to the teachers that he/she needs to go to the restroom before they need to go.
2. Alert him/herself to stop what he/she is doing, to go and use the bathroom.
3. Pull down his/her clothes and get them back up without assistance.
4. Wipe him/herself after using the toilet. (With bowel movements as well as urine)
5. Get on/off the toilet by him/herself.
We will certainly offer the opportunity to use the bathroom multiple times throughout the day. We do understand that even potty-trained children will occasionally have toileting accidents, especially when he/she is in a new environment. By definition, "accidents" are unusual incidents and should happen infrequently. In these instances, the teachers will help children to change their clothes, encouraging independence as much as possible.
Please dress your child in clothing that can be undone and changed easily. Please send a complete change of clothes that is appropriate for the season that will remain in your child’s cubby at school. Parents will be notified if a child has a toileting accident.
I have read, understand and agree to the Potty Training Policy of The Children's Circle and will comply to these requirements.
Parent/Legal Guardian Name
*
First
Last
Parent/Legal Guardian Signature
*
Date
*
MM slash DD slash YYYY
Tuition Policies Agreement
Payment Policy
*
1. The registration fee for all enrolled children is NON-REFUNDABLE.
2. May tuition prepayment is NON-REFUNDABLE and secures my child's placement in the program. The March, April and May tuition prepayment is also NON-REFUNDABLE for Transitional Kindergarten (Fives).
3. Tuition is due on a month in advance payment schedule (i.e., October's tuition is due September 1, and so on, for the remainder of the school year).
4. A late fee of $25 will be assessed to my account if payment is not received by the 5th of the month.
5. If tuition is more than two months overdue, financial arrangements must be made with the Preschool Director or the child will be withdrawn from the program.
I have read, understand and agree to the Payment Policy of The Children's Circle and will compy with these requirements.
Refunds & Withdrawal Policy
*
Tuition payments are non-refundable and non-transferable, except in a situation where the family is relocating out of the city of Charlotte. Exception: March, April and May tuition prepayment is always NON-REFUNDABLE for Transitional Kindergarten (Fives). May tuition prepayment is always NON-REFUNDABLE for all ages.
If it becomes necessary to withdraw your child from the program during the school year, families must provide 30 days advanced written notice prior to the next payment due date. Failure to provide 30 days notice of a withdrawal will require payment of the subsequent month’s tuition.
In the event of an unforeseen school closure, the March, April and May tuition prepayment will remain NON-REFUNDABLE for Transitional Kindergarten (Fives) and the May tuition prepayment will remain NON-REFUNDABLE for all other ages. Any further refunds will be determined at the time of closure by the preschool director, TCC Board and church administration depending on the circumstances, timing and length of such event.
I have read, understand and agree to the Refunds & Withdrawal Policy of The Children's Circle and will compy with these requirements.
Parent/Legal Guardian Name
*
First
Last
Parent/Legal Guardian Signature
*
Date
*
MM slash DD slash YYYY
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