Children’s Open House / Parent Orientation September 4 & 5 2019

Children’s Open House - This is an opportunity for you and your child to meet the teachers, see the classroom and find your cubby and coat hook. Becoming familiar with the classroom will help make the beginning of the school year easier.

Morning Students- If your child comes to the M/W morning preschool, you should come to the open house on Wednesday, September 4th between 9 and 10:30 a.m. If your child comes to the T/TH, morning preschool, you should come to the open should on Thursday, September 5th between 9 and 10:30 a.m. If your child comes all mornings, or to Fridays Arts only, please come to either open house.

Afternoon Students- Please come to the open house on Thursday September 5th between 12:30 and 1:30 p.m. if your child’s last name begins with the letters A-L; please come between 1:30 and 2:30 p.m. if your child’s last name begins with the letters M-Z. (If your child comes to both morning and afternoon programs, please come to either open house, or both!)

Parent Orientation- Our staff wishes to meet with parents to share our philosophy, plans, and expectations. To do this we would like at least one parent or family representative to join us for a parent orientation meeting.

There will be ONE meeting on WED. night, September 4th, 2015. (at 7:00 p.m.) This meeting will take place at the Sisters of Notre Dames building at 30 Jeffrey’s Neck Road (the next driveway) in the auditorium. Take a right at the Statue of St Julie and bear right- go all the way around the back of building. Parking will be marked with balloons. One parent must attend this meeting, it will make the year more successful for all!

ALL YOUR CHILD’S PAPERWORK MUST BE FILLED OUT BY August 1st and received by Kate so it can be properly filed. (We are planning on reviewing files over the summer so the sooner they are returned the better!)

WE MUST HAVE a complete, current MA health form for your child to START school. This is our licensing year so we HAVE TO BE CURRENT with this! No one can start school without an up to date health form! These are good for one year from date of physical, so during the school year, when your

SG/LG/SAEmergencyMedicalConsent20100122

THE COMMONWEALTH OF MASSACHUSETTS Department of Early Education and Care

FIRST AID AND EMERGENCY MEDICAL CARE CONSENT FORM

Child's Name: _______________________________ Date of Birth: ___________________ I authorize staff in the child care program who are trained in the basics of first aid/CPR to give my child first aid/CPR when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the program to transport my child to the nearest medical care facility and/or to ________________________, and to secure necessary medical treatment for my child. Child's Physician Name: ________________________________________________________ Address: ____________________________________________________________________ Phone Number: _______________________ Child's Allergies: ______________________________________________________________ Chronic Health Conditions: ______________________________________________________ Emergency Contacts (In order to be contacted) Name_______________________________________________________________________ Address_____________________________________________________________________ Relationship to child____________________________________________________________ Home Phone__________________________ Cell Phone______________________________ Do you give permission for child to be released to this person? Yes_____ No______ Name_______________________________________________________________________ Address_____________________________________________________________________ Relationship to child____________________________________________________________ Home Phone__________________________ Cell Phone______________________________ Do you give permission for child to be released to this person? Yes_____ No_____ Name_______________________________________________________________________ Address_____________________________________________________________________ Relationship to child____________________________________________________________ Home Phone__________________________ Cell Phone______________________________ Do you give permission for child to be released to this person? Yes_____ No___ ___________________________________________ _________________________ Parent /Guardian Signature Date (valid for one year)

Health Insurance Coverage___________________________________ Policy #________________

Parent/Guardian Name: ________________________________ Phone__________ Cell___________

Parent/Guardian Name: ________________________________ Phone__________ Cell___________

Please attach additional information as needed for the health and safety of the student. MDPH 08/15/13

MASSACHUSETTS SCHOOL HEALTH RECORDHealth Care Provider’s Examination

Name ________________________________________ Male Female Date of Birth:___________________Medical History ________________________________________________________________________________________________________________________________________________________________________________________________Pertinent Family History

Current Health IssuesY N

Allergies: Please list: Medications ______________________ Food _________________ Other ______________ History of Anaphylaxis to ___________________ Epi -Pen�: Yes No

Asthma: Asthma Action Plan Yes No (Please attach) Diabetes: Type I Type II Seizure disorder: ____________________________________________________________________________ Other (Please specify) _________________________________________________________________________

Current Medications (if relevant to the student's health and safety) Please circle those administered in school; a separatemedication order form is needed for each medication administered in school.

Physical Examination Date of Examination:___________________________Hgt: ________(_____%) Wgt:_________(_____%) BMI: _________(_____%) BP: ________(Check = Normal / If abnormal, please describe.)

General ________________ Lungs __________________ Extremities _____________ Skin __________________ Heart ___________________ Neurologic _____________ HEENT _______________ Abdomen _______________ Other __________________ Dental/Oral ____________ Genitalia ________________

Screening: (Pass) (Fail) (Pass) (Fail) (Pass) (Fail) Vision: Right Eye Hearing: Right Ear Postural Screening: Left Eye Left Ear (Scoliosis/Kyphosis/Lordosis)

Stereopsis

Laboratory Results: Lead _______ Date _______________ Other____________________________________

The entire examination was normal :

Targeted TB Skin Testing: Med-to-High risk (exposure to TB; born, lived, travel to TB endemic countries; medical risk factors):TB Test Type: TST IGRA Date: ____________ Result: Positive Negative Indeterminate/BorderlineReferred for evaluation to: _________________________________________ Date:_______ Low risk (no TB test done)This student has the following problems that may impact his/her educational experience:

Vision Hearing Speech/Language Fine/Gross Motor Deficit Emotional/Social Behavior Other

Comments/Recommendations :_____________________________________________________________________Y N This student may participate fully in the school program, including physical education and competitive sports. If

no, please list restrictions:_____________________________________________________________________________________Y N Immunizations are complete: If no, give reason: Please attach Massachusetts Immunization Information System

Certificate or other complete immunization record .

______________________________________________ ___________________________________________Signature of Examiner Circle: MD, DO, NP, PA Date Please print name of Examiner.

______________________________________________Group Practice Telephone

___________________________________________________________________________________________________________Address City State Zip Code

Page 1 of 3 SG/LG/SADevelopmentalHistory20100122

THE COMMONWEALTH OF MASSACHUSETTS Department of Early Education and Care

DEVELOPMENTAL HISTORY AND BACKGROUND INFORMATION

Regulations for licensed child care facilities require this information to be on file to address the needs of children while in care.

CHILD'S NAME: ___________________________________ DATE OF BIRTH: __________________ Please provide information for Infants and Toddlers (marked *) as appropriate to the age of your child.

DEVELOPMENTAL HISTORY Age began sitting: ____________ crawling: ____________ walking: __________ talking: ___________

*Does your child pull up? ____________ *Crawl? _____________ *Walk with support? _____________

Any speech difficulties? _______________________________________________________________

Special words to describe needs ________________________________________________________

Language spoken at home _______________________ *Any history of colic? ____________________

*Does your child use pacifier or suck thumb? _____________ *When? __________________________

*Does your child have a fussy time? ____________________ *When? __________________________

*How do you handle this time? __________________________________________________________

HEALTH Any known complications at birth? _______________________________________________________

Serious illnesses and/or hospitalizations:__________________________________________________

Special physical conditions, disabilities:___________________________________________________

Allergies i.e. asthma, hay fever, insect bites, medicine, food reactions: ______________________

___________________________________________________________________________________

___________________________________________________________________________________

Regular medications: _________________________________________________________________

EATING HABITS Special characteristics or difficulties: _____________________________________________________

*If infant is on a special formula, describe its preparation in detail: ______________________________

___________________________________________________________________________________

Favorite foods: ______________________________________________________________________

Foods refused: ______________________________________________________________________

Page 2 of 3 SG/LG/SADevelopmentalHistory20100122

* Is your child fed held in lap?__________ High chair?__________

* Does your child eat with spoon?__________ Fork?__________ Hands?__________

TOILET HABITS *Are disposable or cloth diapers used? ________*Is there a frequent occurrence of diaper rash?______

*Do you use: oil:_____ powder:_____ lotion:_____ other:_____________________________________

*Are bowel movements regular?______________________ How many per day?___________________

*Is there a problem with diarrhea?_____________________ Constipation? _______________________

*Has toilet training been attempted?______________________________________________________

*Please describe any particular procedure to be used for your child at the center: __________________

___________________________________________________________________________________

*What is used at home? Pottychair? ________ Special child seat? _________ Regular seat? ________

*How does your child indicate bathroom needs (include special words): __________________________

Is your child ever reluctant to use the bathroom? ____________________________________________

Does your child have accidents? ________________________________________________________

SLEEPING HABITS *Does your child sleep in a crib? ________ Bed? ________

Does your child become tired or nap during the day (include when and how long)? ______________

_________________________________________________________________________________

Please note: The American Academy of Pediatrics has determined that placing a baby on his/her back to sleep reduces the risk of Sudden Infant Death Syndrome (SIDS). SIDS is the sudden and unexplained death of a baby under one year of age. If your child does not usually sleep on his/her back, please contact your pediatrician immediately to discuss the best sleeping position for your baby. Please also take the time to discuss your child’s sleeping position with your caregiver.

When does your child go to bed at night? ____________ and get up in the morning? _______________

Describe any special characteristics or needs (stuffed animal, story, mood on waking etc) ___________

___________________________________________________________________________________

child has a physical, we will need a new form!

Page 3 of 3 SG/LG/SADevelopmentalHistory20100122

SOCIAL RELATIONSHIPS How would you describe your child? _____________________________________________________

__________________________________________________________________________________

Previous experience with other children/day care:___________________________________________

__________________________________________________________________________________

Reaction to strangers:_________________________ Able to play alone?________________________

Favorite toys and activities: ____________________________________________________________

Fears (the dark, animals, etc.):__________________________________________________________

How do you comfort your child?_________________________________________________________

What is the method of behavior management/discipline at home? ______________________________

___________________________________________________________________________________

What would you like your child to gain from this childcare experience? ___________________________

___________________________________________________________________________________

DAILY SCHEDULE Please describe your child’s schedule on a typical day. For infants, please include awakening, eating, time out of crib/bed, napping, toilet habits, fussy time, night bedtime, etc. _________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Is there anything else we should know about your child? ______________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________ _____________________________

(Parent/Guardian Signature) (Date)

Permission Form

Child’s name ___________________ Birthday _______________ Allergies _____________

Parent’s names _____________________________________________________________

Parent’s cell phone __________________________________________________________

Cell phone providers (need to set up texting system) _______________________________

All children should come to school with the appropriate bug spray and sunblock. This

permission is for those who need it reapplied.

Hats, long pants, sock and sturdy shoes are recommended. Boots are ideal for most of the

year with a pair of slippers or indoor shoes.

My child may use the general bug spray yes ___________ no thank you __________

(If no, please leave us with a labeled container of bug repellant for your child)

My child may use the general sunscreen yes ___________ no thank you ___________

If no, please provide a labeled container of sunblock)

My child’s picture may be used on:

Cuvilly website yes _____________ no thank you _____________

Cuvilly’s Facebook/Instagram yes _____________ no thank you ______________

Newspapers / Magazines yes ____________ no thank you ______________

Cuvilly promotional materials (posters/brochures)

yes ____________ no thank you _______________

Page 1 of 2 SG/LG/SAChildEnrollmentForm20100122

The Commonwealth of Massachusetts Department of Early Education and Care

Child’s Enrollment Form

Child Information

Child’s Name:_________________________________ Date of Birth:_____________________

Age at Admission:______________________________ Date of Admission:________________

Child’s Home Address:__________________________________________________________

Home Phone Number:__________________________________________________________

Primary Language:______________________ Identifying Marks:________________________

Eye Color:_____________ Hair Color:_____________ Skin Color:_______________________

Sex:__________________ Height:________________ Weight:__________________________

Parent/Guardian Information

Parent/Guardian Name: _______________________________________________________

Relationship to Child:___________________________________________________________

Home Address:________________________________________________________________

Reachable Phone Number:______________________________________________________

Email Address:________________________________________________________________

Business Name:_______________________________________________________________

Business Address:_____________________________________________________________

Business Phone Number:________________________________________________________

Hours at Work:________________________________________________________________

Parent/Guardian Name:_________________________________________________________

Relationship to Child:___________________________________________________________

Home Address:________________________________________________________________

Page 2 of 2 SG/LG/SAChildEnrollmentForm20100122

Reachable Phone Number:______________________________________________________

Email Address:________________________________________________________________

Business Name:_______________________________________________________________

Business Address:_____________________________________________________________

Business Phone Number:________________________________________________________

Hours at Work:________________________________________________________________

Additional Information

Child’s Physician:______________________________________________________________

Address:_______________________________________ Phone Number:_________________

Allergies/Special Diets?_________________________________________________________

Individual Health Plan for child with a chronic health condition? If yes, please attach._________

Copies of any custody agreements, court orders, and restraining orders pertaining to the child? If yes, please attach.____________________________________________________________

Special limitations or concerns? __________________________________________________ ____________________________________________________________________________

School Age Only

Current School:________________________________________________________________

School Address:_______________________________ School Phone Number:____________

I certify that documentation of physical examination and immunizations in accordance with public school health requirements and lead poisoning screening in accordance with public health requirements are on file at my child’s school. Parent/Guardian initials:

_______________________________________________ _________________________ Parent/Guardian Signature Date

Hop-a-thon 2019 Parental / Guardian Consent Form

Dear Parents: We are sending you this parental consent form to request permission for use of your child’s name and photo / image to be used to create an individual fundraising link for the upcoming 2019 Hop-a-thon, our online annual fundraiser to support the costs associated with the upkeep of all our animals. * Please note that each campaign link is private and not published. You decide with whom you want to share your child’s link. In 2018, Cuvilly held its first ever online fundraiser campaign and each child had his or her own link to a personalized fundraising page using the platform of the kind.fund.com. This personalized campaign link with each child’s name was of special convenience to those who wanted to easily share their child’s link with family and friends over email (or to share on Facebook or other social media sites). While sharing on social media is not required, it was a feature many parents loved as it helped to get the word out to even more people and generated even more support for each child’s hop-a-thon than in years before. Children having their own individual customized links using a photo with their favorite Cuvilly critters are what made the fundraiser such a huge success. To see an example of the campaign (Sister Pat’s is an active campaign), go here: https://kind.fund/campaign/sister-pat-s-hop-a-thon-fundraiser-campaign

Pursuant to law, we will not release any personally identifiable information without prior written consent from you as parent or guardian. Personally identifiable information for the express purpose of the hop-a-thon includes only the student name and their photo or image. If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by sending a letter school and such rescission will take effect upon receipt by the school.

Please check one of the following choices and sign below: ▢ I/We GRANT permission for a photo/image and first and last name that includes this student without any other personal identifiers to be published as a private campaign link on the kind.fund. ▢ I/We GRANT permission for a photo/image and first name only that includes this student without any other personal identifiers to be published as a private campaign link on the kind.fund.

▢ I/We DO NOT GRANT permission for photo/image that includes this student to be published as a private campaign link on the kind.fund. Instead, we will opt to use a general Cuvilly campaign.

Student’s Name: (please print) _________________________________ Print name of Parent/Guardian: (print) ______________________________________________ Signature of Parent/Guardian: (sign) _______________________________ Date:____________Relation to Student: ___________________________________________________________

2020

2020

Cuvilly Arts & Earth Center Field Trip Permission Form:

The Cuvilly Arts & Earth Center will take ________________________________ on WALKING field trips on the Sisters of Notre Dame property only, from Sept 2019 through June of 2020.

My child has permission _____ my child does NOT have permission _______

Farm Chore Permission Form:

The children will be watering the animals, cleaning the stalls, grooming the donkeys as well as working in the gardens and pastures. The children will be supervised by a teacher and another adult at all times. Safety always comes first with us.

My child has permission to participate in the farm chores ________

My child DOES NOT have permission to participate in the farm chores ____________

(Another activity will be provide)

Cuvilly Art & Earth Center Transportation Plan and Authorization

Child’s name __________________________________________

My Child will arrive at the program My Child will depart from the program

• _____parent (or parent arranged) drop off ____parent (or parent arranged) pick up

• ____ supervised walk ____ supervised walk

• ____ unsupervised walk ____ unsupervised walk

• ____ public/private/van ____ public/private/van

• ____ contract van ____ contract van

• _____ private trans arranged by parent _____ private trans arranged by parent

• _____ other (please explain below) _____ other (please explain below)

The following people have permission to drop off/pick up my child:

NAME _______________________________________ phone number _______________

NAME _______________________________________ phone number _______________

NAME _______________________________________ phone number _______________

NAME ________________________________________ phone number _______________

(Please know that an ID will be required if we do not know the person)