Enrollment Forms

Registration and Security Deposit Agreement and Terms

Child’s Name ______________________________________ Child’s Date of Birth________________

Parent’s Name ______________________________________________________________________

Home Address ______________________________________________________________________

Phone Number______________________________________________________________________

My start date for the program will be ____________________________________________________

My Child’s room will be ________________________________________________________________

My Child’s schedule: Monday_____ Tuesday_____Wednesday______Thursday_______ Friday________

My Child will be dropped off at _________________ My Child will be picked up at ______________

Tuition Mode is: Weekly _______________________ Monthly _______________________

Applicable Fees:

The registration fee for the program I have selected is ____________. This fee is non-refundable.

I am required to leave a 2 week security deposit in the amount of _______________ in order to assure placement of my

child. Ivy League acknowledges and assures that space will be available on my child’s start date. My security deposit is non-

refundable. Failure to start on the above mentioned date will result in loss of my security deposit.

- I am required by this contract to give a 2 week written notice of withdrawal, if my child will no longer be attending

this program. Once notice is given, my deposit will be applied to my last two weeks of enrollment. My account will

be billed out at the time of notice, and my deposit will be applied. If any payment is due at the time of notice, your

account must be paid in full at that time.

- If my programs changes, my security deposit will be adjusted to remain current with the selected tuition rate.

- If for any reason, I do not start my child in the program, I understand that I will forfeit my registration and security

deposit.

- You are considered enrolled in the school as soon as the registration fee and/or security deposit is paid.

- I understand and agree, to all terms and conditions of this agreement and the Enrollment agreement.

Parent/Guardian signature ________________________________________ Date_____________

Administrator’s signature __________________________________________ Date_____________

First link Please review the entire student enrollment packet and Family Policy and Enrollment Agreements with each family. Be sure that all forms are filled out completely with appropriate signatures. Review the child’s health record and Immunizations for State compliance to ensure the physician has stamped/signed it and has filled in all the necessary dates.

Obtain Signed Forms From Family

Standard Enrollment Packet

Permission form for after school pickup, field trips

& emergency care

Authorization for Student Pickup

Child Information Card

Family Policy Agreement

Enrollment Agreement

Other State or Federal required forms:

Review with Family

The child’s first day

Child guidance and classroom management

(discipline policy)

Tuition payment schedule, amounts and due dates

Parent conferences and other communications,

what to expect daily and/or weekly

Process and Procedures of Security Access

Authorized pickup, late pickup policy and

emergency controls

Child Custody Documents (if applicable)

Clothing and other items to bring (labeled)

Any pickup restrictions

Any field trip restrictions

Any photo restrictions

Immunization/Health information

Annual registration fee

Late fees

Vacation policy

Special needs

Absenteeism policy

Sick policy

Meals

Allergies

Security deposit (if applicable)

Medication policy

Relevant curriculum features for child’s age group

Infant/Toddler Needs Services Plan (if applicable)

The information above was reviewed with me and all of my questions have been answered to my

satisfaction. I have a clear understanding of Ivy League’s policies.

Name Parent/Guardian signature relationship Date

Name Owner/Dire ctor signature title Date

ENROLLMENT FORMS

FIRST PARENT/ GUARDIAN INFORMATION

Last Name First Name

Address City State Zip

Home Phone

Cell Phone

Driver License State Social Security Number

Place of Employment Corp. Partner

Work Address City State Zip

Work Phone Work Hours Title Email Address

How did you hear about us?

SECOND PARENT/ GUARDIAN INFORMATION

Last Name First Name


Home Phone Cell Phone

Driver License State Social Security Number

Place of Employment Corp. Partner

Work Address City State Zip

Work Phone Work Hours Title Email Address

How did you hear about us?

PEDIATRIC PHYSICIAN & DENTIST INFORMATION

Dr. Last Name First Name

Office Phone Number


Dentist Name Phone Number

Hospital Name Phone Number

Insurance Carrier Policy #

Primary Insured Social Security Number

CHILD'S BASIC INFORMATION

Last Name First Name Date of Birth

Gender Social Security Number

Restrictions:

Parent * Yes No Comment:

*Where restriction is requested, you must provide documentation showing legal rights.

Field Trip Yes No Comment:

Photo Yes No Comment:

Other Yes No Comment:

Please give details of other restrictions

Allergies* Yes No Comment:

*Must have documentation of allergies

CHILD'S PROGRAM INFORMATION

Application Date Expected Start Date

(School Age Child) Name of School Time of Dismissal

Expected Schedule:

Mon Tues Wed Thurs Fri

Program Classroom Tuition Mode Amount

Registration Fee Security Deposit Start Date Drop Date

A copy of THIS FORM, for each child, shall be placed in a 1" binder separated alphabetically by

last name and taken on the bus/van for each field trip or to the emergency evacuation site.

AUTHORIZATION FOR MEDICAL TREATMENT OF A MINOR

In the event of an emergency requiring a physician's care, do you wish us to call your family physician? Yes No

Name Phone Number


I (we), do hereby state that I am (we are) parent(s) or

legal guardian(s) of _, who resides with me (us) at

I (we), authorize for emergency purposes only, a designated

employee of the center to transport the above minor by ambulance & consent to any necessary

exam, anesthetic , medical advice and/or medical treatment from a physician or surgeon licensed to

practice medicine in the State of

Allergies to drugs or food

Last Tetanus/ Diphtheria Booster

Please list any special medications or pertinent information

AUTHORIZATION

Parent(s) Legal Guardian (s) Signature(s) Date

Center Director (witness) Date

EMERGENCY CONTACTS AND AUTHORIZED PICK UP (in order of preference)

Name Relationship Daytime Phone





PASSWORD FOR UNUSUAL PICKUP AUTHORIZATION

This password should be kept confidential. Only the parent and the Center Director will know it.

The password is used as a mean of positively identifying a parent if they call the center to

authorize an unusual pickup. The pickup person does not need to know the password. They just

need a photo ID.

AFTER HOURS

If a child has not been picked up by closing time, it is the responsibility of the Center Director to

attempt to contact the parents and every authorized pick up person listed on this form. If no contact

can be made to arrange a pick-up, legal authorities must be notified. If these authorities are also

unable to make a contact, the child must be cared for as directed by these authorities. The staff is

not permitted to remove the child from the child care center and continue to provide care in their

home or any other location.

Signature (Parent or Legal Guardian) Date

Signature (Parent or Legal Guardian) Date

Witness Date

CONSENT AND RELEASE

For film, photos, internet, intranet, as well as any other form of electronic or digital communication

On various occasions, your child may be photographed while at Ivy League Early Learning Academy.

These photographs may be used by Ivy League Early Learning Academy and/or its affiliated

companies, in program planning and/or public relations. They also may be used in various types of

advertising, or by public television, newspapers, magazines, electronics, social media, or

digital communication. For this reason, we request that each parent sign the following release"

PARENT CONSENT

I hereby, give, or do not give, Ivy League Early Learning Academy and its agents, the absolute right

and permission to copyright and/or publish, or use photographic portraits or pictures of my child,

or reproductions thereof in color or otherwise, made through any media for art, advertising, trade

electronic or digital communication or any other lawful purpose whatsoever. These pictures may

be used in conjunction with his/her own or fictitious name.

No, I do not grant full permission

Yes, I do grant full permission

Yes, I grant permission for internal use only

Child's Name Age Date

Parent/Guardian Signature Date

Center Director's Signature Date

Ivy League School Name City and State

PARENT PERMISSION FOR AFTER SCHOOL PICKUP, FIELD TRIP OR EMERGENCY

We may plan special field trips for the children away from the school. These trips are carefully

arranged and shall be supervised by an adequate number of adults. You will be notified of all

such trips that require transportation and a special permission form will be required. This also

includes children taking walks and infants strolling in their buggy off school property . You will

always receive advanced notice of ALL field trips.

We have your permission to take your child, _on these field trips,

as described above


Witness Date

We have permission to pick up your child, _, on a daily basis from

school.


Witness Date

For emergency purposes, our emergency evacuation site is:


Witness Date

Enrollment Agreement

Child’s Full Legal Name _____________________________________________________________

Date of Birth _____________________________________________________________________

Parent / Legal Guardian Name(s) _____________________________________________________

________________________________________________________________________________

Please initial each section listed below, then sign and date on the last page

TUITION and MODIFICATIONS CONDITIONS

I have enrolled my child in the following program(s)

From_____________________ am/pm to ________________________am/pm

Monday Tuesday Wednesday Thursday Friday

AGENCY REIMBURSEMENT

I understand that I am solely responsible or any tuition payment and late fees in excess of any agency or

third-party reimbursement in accordance with the applicable contract. I also understand that I am solely

responsible for promptly communicating any changes in my status that would affect my agency

reimbursement, and that I am solely responsible for payment to Ivy League Early Learning Academy of any

tuition in excess of any agency or third-party reimbursement resulting from my failure to promptly

communicate status changes.

Government (HRA) co-payments are due the Friday prior to service. If not paid on that Friday enrollment

will be immediately suspended until your account is current.

______

PAYMENT OF TUITION

All fees (materiel, learning, etc.), deposits, and registrations are non-refundable

Monthly Payments: $______________ due on the 1st (pre-paid). A late fee of $50 will be charged if

tuition is not paid by the first (1st), an additional $5 will be charge each day thereafter. If your account is

not paid in full by the fifth (5th) of the month, enrollment will be suspended until your account is current.

Weekly Payments: $______________ due on Friday before the week service is provided (pre-paid). A

late fee of $30 will be charged if tuition is not received by close of business on Friday, an additional $5 will

be charged each day thereafter. If your account is not paid in full by Wednesday, enrollment w ill be

suspended until your account is current.

If payment in full is not received when due, I agree to pay a late payment fee per week/month or part of

each week/month that tuition is not received. All late fees are subject to change without notice. I

understand that if my account is delinquent according to the weekly/monthly payment of tuition terms I

will be asked to withdraw my child until my account is made current. Payments are still due and accruing

during suspension. The center cannot guarantee a child’s spot will be held when a child is withdrawn due

to non-payment of tuition. Any unpaid tuition fees may be sent to a third-party collection agency. Any

accounts going to collection or any outside services for collection, you will be responsible for payment of

those fees.

RETURNED CHECKS

I understand that a processing fee of $50 will be charged to my account for all checks which are returned

for any reason. This fee is in addition to any charges that my bank or financial may charge me. I further

understand that once a check has been processed electronically the check is no longer negotiable and will

not be returned. If more than 2 checks are returned within a calendar year, I will be required to pay by

money order, cash or credit card. Late fees will be applied for all returned checks.

REGISTRATION FEE

I understand that an annual, non-refundable, registration fee of $100 per child shall be paid in advance to

enroll my child. I Understand that I may guarantee my child’s enrollment for fall by paying this fee no later

than 8/15 each year. In instances of agency of reimbursement, the registration fee is to be paid according

to the applicable contract. Upon payment of registration fee a start date will be given. Any changes in start

date will require new registration fee, which is non-refundable.

SUMMER REGISTRATION, ACTIVITY FEES, AND EARLY LEARNERS FEE

School age camp will be open during the summer months according to the local public school calendar.

Camp children will pay a separate registration and camp tuition fee during these months. Preschoolers will

have a separate summer activity fee. Other age groups may also incur a summer activity fe e. Please

consult the Center Director for details. In instances of agency reimbursement, the summer registration and

activity fee will be my responsibility.

LEARNING MATERIAL FEE

Fee for children in our Pre-school and Pre-K programs of $50.00 is due each semester (September and January). Learning material fee for children in our Young Learner program (Infants – Prepper) of $25.00 is due each semester (September and January)

DISCOUNTS

A ten percent (10%) discount is offered to me for each additional child from my immediate family enrolled

in the center. The discount is applied to the lowest tuition rate. These discounts are available only to those

accounts when full tuition is paid in advance. Discounts are not applicable to the registration fee,

curriculum/program fees, agency co-pays, special program promotion or for any other fees or services and

cannot be combined with any other discounts or promotions.

ADMINISTRATORS FEE

Failure to supply current and valid emergency contacts will result in your account being charged with a

twenty-five ($25) dollar administrator fee.

CHARGES AND PROCEDURES FOR LATE PICK-UP

Our school closes at 6:30 p.m. All families must be on time picking up their child. You must make sure

that you leave ample time to be out of the building at 6:30pm. Any family picking up after 6:30pm will be

charged $30 for each 15 minute period of time. This fee is due upon pick up. If this fee is not paid at the

time of pick up, late fees will be charged.

ENROLLMENT: I understand that the completion and execution of any forms and the payment of any tuition, timely or in advance, is not a guarantee of enrollment, continued enrollment or re-enrollment. My child may be refused enrollment or may be dis-enrolled at any time, with or without notice, when it is believed, at Ivy League’s sole discretion, that discontinuing or refusing enrollment is in the best interest of my child, the center or the other children in Ivy League’s care. I further understand that enrollment at Ivy League is not a guarantee of academic or other success, progression or promotion. ___ _____ _____

INCLEMENT WEATHER OR OTHER DISASTERS I understand that it is Ivy League’s intention to be open and provide child care service every weekday of the year, excluding holidays, but that inclement weather, natural/national disaster or major building issue may disrupt service from time to time. I will contact the center to ensure that it is open during inclement weather/natural disaster. I agree that in the event that the center is closed for an extended period of time. I will continue to be responsible for my tuition payments for up to three days.

HOLIDAYS:

I understand that the center is closed on the following holidays: New Years Day, Memorial Day, Independence day, last Friday in August, Labor day, Martin Luther King Jr day, President's day, Thanksgiving day, the day after Thanksgiving and Christmas day. The center will be closed at 3pm on Good Friday, Christmas Eve and New Year's eve. I agree that I will not receive a refund, credit or any other allowance for holidays. If a holiday falls on a weekend, it will be observed on either the preceding Friday or the following Monday.

ABSENCES

I agree to inform the center immediately if my child(ren) will be absent on any day. I understand that no allowances, credits, refunds or make up days shall be made for occasional absences. My regularly

contracted tuition is due for all weeks when my child attends any part of the week. If my child is absent for an entire week, I may choose to use a Vacation Credit. The terms of a Vacation Credit are as follows: After six (6) continuous months of enrollment, I may elect to use one week of Vacation Credit

when my child is not in attendance for an entire week Monday through Friday. During the Vacation Credit week, my regular tuition charge will be reduced by 50%. There is a two (2) week maximum annual Vacation Credit allowance which is non-cumulative and must be taken in full week increments.

There is no credit given for single days and vacation credits may not be carried over.

WITHDRAWL FROM PROGRAM

I understand that I must provide a two (2) week written notice of withdrawal from the program. If this

notification is not provided, I agree to pay all tuition and fees for two (2) weeks, whether or not my child attends. I understand that when my child is withdrawn, s/he will only be eligible for re-admission based upon space availability and all other enrollment criteria. If my child is selected for re-enrollment, I will be

required to pay a new non-refundable Registration Fee. If there is an outstanding balance (including tuition or fees) when my child was withdrawn, I will be required to bring my account current prior to completing a re-enrollment application. I understand all fees (Registration or Activity) are non-refundable.

CHILD ACCIDENT INSURANCE

Supplemental child accident medical insurance is provided as a complimentary service to reimburse the

cost of medical treatment resulting from any injury to my child while in Ivy League’s care. I understand that this is an excess policy only and that my health insurance is and remains the primary responsible party for payment for the cost of treatment for my child(ren). I also understand that the policy requires a

$50 deductible for each incident, and that I have one year from the date of injury to make a claim under this policy. I further understand that I am solely responsible for initiating a claim, for requesting all appropriate forms from the center and for tracking the status of my claim.

DAILY SIGN IN AND SIGN OUT

I agree to sign my child(ren) in and out every day on the Ivy League’s computer accounting system. I

understand that my child is not permitted to sign him/herself out. I understand that I am required to enter the center to drop off and pick up my child(ren) and that I must escort my child(ren) to and from the designated classroom each day. In states where a manual signature is required due to state child care

licensing regulations, I agree to complete the required computer and manual sign-in and sign-out procedures.

RELEASE OF CHILDREN

I understand that my child will only be released to me, a parent or legal guardian (except where prohibited by state child care law or court order) and to those persons whose names I have listed on the

Authorization for Student Pick-up form. I understand that Ivy League may require, at any time and without notice, satisfactory proof of identification and a valid driver’s license from any person, including myself, who proposes to pick up and transport my child(ren). I understand that,

for the safety and security of my child(ren), if an emergency were to arise where an unauthorized person must pick up or drop off my child(ren), I will be required to provide a password or other verification, as directed by the center. I will be required to follow the center’s instructions for Student Release to an

Unauthorized Person policy which requires a photo ID from the person picking up my child and the completion of a release form which I must sign upon my next arrival at the center. I understand that Ivy League has the right to refuse to release a child to any person, including myself, who fails or refuses to

follow Ivy League’s Sign-In, Sign-Out and Child Release policies, or to any person who appears, in the sole discretion of Ivy League, unable to safely transport my child(ren). I understand that no person under the age of 18, including family members but excluding emancipated minor parents, may pick up a child

from the center.

MODEL RELEASE

Ivy League Early Learning Academy, its agents, affiliates and licensees, may may not use

photographs, reproductions, images or sound recordings of my child for advertising, publicity or any other

lawful purpose.

CHILD INFORMATION

I understand that it is my sole responsibility to inform Ivy League of any changes in my personal information or my child’s personal information including, but not limited to, address, home phone

number, work phone number, cellular phone number, pager number, days and hours of work, days and hours of school, transportation arrangements, child’s medical conditions and any changes that may affect my child’s enrollment. I understand that Ivy League will not be responsible for errors or claims resulting

from my failure to provide current personal information.

EMERGENCY CONTACTS

I understand that I am required to provide and maintain at all times a minimum of two (2) additional emergency contacts other than myself, including full names, home and work phone numbers, cellular

phone numbers, addresses, driver’s license numbers or state identification numbers, and relationship to my child(ren). I understand that in the event of any emergency for which I cannot be reached and the emergency contacts cannot be reached, that the center may contact the police or other local authorities

for assistance.

CENTER SAFETY

I understand that Ivy League has an open door policy for parents and legal guardians and that I have unlimited access to the center, while my child is in attendance. I understand that access to the center may be restricted to custodial parents pursuant to state child care regulations, or may be further

restricted by court order. I further understand that, for any reason it deems appropriate for the preservation of the safety, security, health or general wellbeing of the center, Ivy League may temporarily or permanently exclude any person from the center, including a parent, whom Ivy League finds at its

sole discretion, poses or is likely to pose a risk to the center or who fails or refuses to conduct him or herself in a manner befitting a child care environment. Prohibitions include but are not limited to: profanity, yelling, threatening, aggressive or violent behavior, intoxication or failure to follow Ivy League

policies and procedures. INTERVIEWING CHILDREN AND

INSPECTING RECORDS:

I understand that the state child care regulatory enforcement and administration agency and the local department of social services or child protective services has the authority to interview children or staff,

to inspect and audit child or facility records, to interview children privately, to observe the physical condition of the children in the center, to make provisions for the independent medical examination by a licensed physician of any child, and to contact and instruct any other appropriate authority to do the same,

without prior notice or consent by myself or by Ivy League.

ILLNESS AND RE-ADMISSION

I understand that I will be notified should my child become ill during the day, and that I will pick up my child promptly upon such notification. If my child is exposed to or contracts a contagious disease, I agree to

notify the center and I understand that my child will be re-admitted according to the Ivy League Re-admission Criteria in the Policy Agreement. Additionally, I understand that if I am notified to pick up my child due to illness, arrangements must be made within one (1) hour. Failure to comply will result in late

fees.

MEDICATION

I understand that Ivy League is not required to administer any medication, and that I must administer all

prescription and over-the-counter medication. If medication must be administered during the day, I agree to fill out the Non-Prescription Medical Treatment Instruction, Consent and Waiver form or the Authorization for Administering PrescriptionMedical Treatment Waiver and Consent form and

give the medications and completed forms to the appropriate management person in charge. I understand that I must strictly follow all Ivy League policies related to the administration of medication in the center, and that Ivy League may refuse to administer any medication at any time, without notice

when, at Ivy League’s sole discretion, such action is in the best interest of my child

PERSONAL ITEMS:

I understand that Ivy League is not responsible for lost or damaged personal items. I will ensure that

my child(ren)’s clothing, backpacks and other personal items are clearly labeled with child(ren)’s first and last name.

ALL IVY LEAGUE POLICIES & STATE REGULATION:

I understand that the above policies are not an all-inclusive list of policies, and that my child(ren), my family members, authorized agents and I are bound by state child care regulations, the Policy Agreement, and all other Ivy League policies, which may be modified at any time, without notice. I

also understand that the child care regulations of the state in which my child attends may prevail over these Ivy League policies when the state regulation is stricter. I further understand that my continued enrollment at Ivy League constitutes my acknowledgement of, and agreement to abide by,

all Ivy League Policies and state regulations.

CELL PHONE FREE ZONE

Cell phones are not permitted to be use in the school at any time. I agree that I will not use or have

my cell phone out at any time with on school property. OUTSIDE FOOD AND TOYS

For the safety of all children food may not be brought in from the outside. We have many children with severe food allergies. We must insure a safe environment and follow mandated policies for

food safety. If you would like to have a birthday celebration for your child, all items must firs cleared with your child teacher. All of the items must be prepackaged with the ingredients label

visible. We are nut free, egg free and latex free school. You are prohibited for giving you child food in the hallways or any other area of the school. Food served in a classroom, may not leave that classroom. You child may not bring in items from the outside; they may contain small parts

that are choking hazards to children. Each toy and learning material supplied by the school is safety for children in the school; we do not have this safety check for item being brought from

home. Any item (food of toy) that is brought in to the school will be disposed of. NO MODIFICATIONS:

No terms of this Agreement may be altered, revised, modified or deleted by any person except in

cases of Ivy League policy change or rate change to which both Ivy League and I must initial. Any alterations, revisions, modifications or deletions of any term of this Agreement are null and void.

These policies have been reviewed with me by center management. I understand and will comply with the policies included in Ivy League’s Enrollment Agreement and Policy Agreement. Policies in this contract will supersede all other previous documents.

Parent or Legal Guardian: (Signature) (Date)

(Printed Name)

Center Director Signature: ____________________________________________________________