Enrollment Contract

Lil’ Red Barn Academy Child Care & Preschool Enrollment Contract

Date child entered care
Date Format: DD dot MM dot YYYY
Date child left care
Date Format: MM slash DD slash YYYY
Child's Name
First Middle Last
Name (Nick Name) Used
Birth date
Date Format: MM slash DD slash YYYY
Street Address City Zip code
Child's parent/guardian name
Home phone#
Cell phone#
Alternative phone
Street Address City Zip Code
Address where you can be reached while child is in care City Zip Code
Child's parent/guardian name
Home phone#
Cell phone#
Alternative phone#
Street Address City Zip Code
Address where you can be reached while child is in care City Zip Code
Other than you, who else has permission to pick up you child?
Name Relationship:
Address
Home Number:
Cell Number:
Alternative Number:
Name Relationship:
Address
Home Number:
Cell Number:
Alternative Number:
Name Relationship:
Address
Home Number:
Cell Number:
Alternative Number:
Name Relationship:
Address
Home Number:
Cell Number:
Alternative Number:
In Case of an emergency, I give permission for any of the following individuals to be contacted any my child may be releaed any of them.
Parent/Guardian Signature:
Name Relationship:
Address
Home Number:
Cell Number:
Alternative Number:
Name Relationship:
Address
Home Number:
Cell Number:
Alternative Number:
Name Relationship:
Address
Home Number:
Cell Number:
Alternative Number:
Who does not have permission to pick up your child? If applicable (A copy of supporting court document must be on file)
Name
Reason
Name
Reason
Child’s health information
Date of child's last physical exam:
Date Format: MM slash DD slash YYYY
Child's health care provider
Telephone number
Street Address City Zip Code
Child dentist's name
Telephone number
Street Address City Zip Code
Special health Problem?
- Yes
- No
Allergies, including drug reactions
- Yes
- No
Regular medications?
- Yes
- No
Other Important information
- Yes
- No
Child's dentist's name
Telephone number
Street Address City Zip Code
Child’s medical insurance coverage
Insurance company name
Member/policy number
Policy holder name
Employer name
Insurance company name
Member'policy number
Policy holder name
Employer name
Consent to medical care and treatment of minor children
I give permission that my child
may be given first aid/emergency treatment by a the child care licensee and/or qualified staff at:
Name of Licensee
Address of Licensee
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
When I cannot be contacted. I authorize and consent to medical. surgical and hospital care. treatment and procedure to be performed for my child by licensed physician. health care provider, hospital or aid car attendant when deemed necessary or advisable by the physician or aid car attendant to safeguard my child’s health. I waive my right of informed consents to such treatment.

I also give my permission for my child to be transported by ambulance or aid car to an emergency center for treatment.

I certify under penalty of perjury under the laws of the state of Washington that this information is true and correct.
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
Lil’ Red Barn Academy Child Care & Preschool Acknowledgment Contract
Field Trip/Activity Fees

Our center offers several filed trips and special activities throughout the year. Transportation will be provided if necessary by Lil’ Red Barn Academy. You will be notified in advance of any scheduled field trip or event. Parents are responsible for any fess.
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
Photograph Release

I release Lil’ Red Barn Academy to photograph and/or video my child while participating in daily activities and to use the photographs and/video in public display or other publication showing these daily activities.
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
I release Lil’ Red Barn Academy to photograph and/or video my child while participating in daily activities. These photographs will be used in house only. Example; field trips, special events, class picture etc.
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
Termination of Child care services
Lil’ Red Barn Academy reserves the right to terminate childcare services when:
A child’s behavior is injurious to the well being of other children/staff.
A parent’s behavior disrupts the program
Childcare payments are not made on time
The parent guidelines are not being followed
The child does not follow the schedule provided in the financial agreement
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
Lil Red Barn Academy Child Care & Preschool Financial Contract
- A monthly tuition is charged according to scheduled days, regardless of attendance
- All tuition and co-pay payments are due on the 1st of the month and late after the 3rd of every month
- After the 1st of the month, there will be a $15 late charge fee, per day applied to your account
- If payment is not made on the 1st , child(ren) will not be permitted to attend until payment is made in full
- If your child(ren) is expelled from Lil’ Red Barn Academy due to behaviors made by the child and/or parent, no refund will be given
- If you choose to withdraw your child(ren) from Lil’ Red Barn Academy Child Care & Preschool, a 30-day written notice (or one calendar month) must be given
- If you choose to withdraw your child(ren) from Lil’ Red Barn Academy Child Care & Preschool, for ANY ACCOUNT CREDIT TO BE GIVEN, the last day of care must be on or before the 15lh of the month and 30-day notice must be given. If the last day of care will be after the 15th of the month or the proper notice is not given, the total monthly bill will be due at the beginning of the month as usual
- Late pick up charge: $1 per minute, per child after 6:00pm closing time
- Diapers: Our staff will always notify you if your child(ren) need diapers. There will be a r charge of $1 per diaper provided by Lill Red Barn Academy
- Holiday Closures: Lil’ Red Barn Academy will be closed the following holidays. Swapping scheduled days for holiday closures is not permitted
  - Labor Day
  - Presidents Day
  - Thanksgiving Day & The Day After
  - Christmas Eve & Christmas Day
  - New Years Day
  - Memorial Day o Fourth of July
  - MLK Day
  - I agree to pay Lil’ Red Barn Academy according to my child(ren)’s schedule, not attendance. I agree to all above terms and financial contract obligations.
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
Parent/Guardian Signature
Date
Date Format: MM slash DD slash YYYY
Enrollment Contract
Please initial next to each statement.
By filling out this form, I certify that I have received a current copy of Lil’ Barn Academy’s
Parent Handbook
Disaster Plan
Healthcare Policy
You also do agree to abide by the polices and procedures contained therein.
I understand the medical policy and that Lil’ Red barn Academy must have a copy of my child’s immunization records and must be kept up to date.
I understand that tuition is due and payable when scheduling for my child’s care
I understand that tuition must be paid in advance of any child care.
I understand that there is a $10.00 per day late fee after the 3 day grace period. Childcare serves may be suspended until services are paid including late fees
I understand the illness policy.
I understand the policy for other people, other me picking up my child.
By singing below, you agree that this a legally binding form, and that you agree to adhere to all of the polices listed above. As well as in the parent handbook
Signature
Date
Date Format: MM slash DD slash YYYY
Signature
Date
Date Format: MM slash DD slash YYYY
CAPTCHA

Lil’ Red Barn Academy Child Care & Preschool Enrollment Contract

Lil’ Red Barn Academy Child Care & Preschool Acknowledgment Contract

Field Trip/Activity Fees

Photograph Release

Termination of Child care services

Lil Red Barn Academy Child Care & Preschool Financial Contract

Enrollment Contract

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