Child Profile
Distribution •Child’s File •Infant/Toddler Classroom Log •Pre-School/School-Age Classroom Log Child Profile For children ages 1 and up A new form is required with each classroom transition This profile will help your child’s teacher get to know your child better. Your input will also help with your child’s adjustment to the new classroom. Child’s Full Name: _________________________________ Date of Birth: ___/___/___ Parent/Guardian’s Name: __________________________________________________ (Please Print) 1. List any nicknames your child may have. ___________________________ _____ 2. Has your child had previous group care experiences? □ Yes □ No 3. What language(s) is spoken in your home? ______________________________ 4. List the names and ages of siblings. 5. Do you have pets at home? □Yes □ No If yes, please list type of pet and name. _________________________________________________________________ 6. What words are spoken in your home to describe everyday things (I.e. toileting, nap, eat, play and outside)? ________________________________ Parent/Guardian Signature ____/____/____ Date KRK/102/REV/03/11 Distribution • Child’s File • Infant/Toddler Classroom Log Infant Child Profile For children ages 6 weeks- 12 months A new form is required with each classroom transition This profile will help your child’s teacher get to know your child better. Your input will also help with your child’s adjustment to the new classroom. Child’s Full Name: _________________________________ Date of Birth: ___/___/___ Parent/Guardian’s Name: __________________________________________________ (Please Print) 1. Has your child had previous group care experiences? □ Yes □ No 2. What language(s) is spoken in your home? ______________________________ 3. List the names and ages of siblings. 4. Do you have pets at home? □Yes □ No If yes, please list type of pet and name. _________________________________________________________________ 5. What milestone(s) has your child reached? (I.e. rolling over or crawling) 6. Does your child take a pacifier? □ Yes □ No When? _______________________ 7. How often and how long does your child nap? ___________________________ 8. How many hours does your child sleep at night? __________________________ 9. List any additional care plan instructions, i.e. diapering or sleeping ___________ _________________________________________________________________ _________________________________________________________________ ________________________________ Parent/Guardian Signature ____/____/____ Date KRK/105/REV/03/11 Distribution Child’s File Transportation Log Field Trip Log (School-Age Only) Health and Emergency Permission This form must be completed for all enrolled children Child Child’s Full Name ____________________________________ Age _____ Gender______ Date of Birth ___/___/____ Child’s Home Address _____________________________________ _____________________________________ Home Phone _______________________ Parent/Guardian(s) Parent/Guardian Name_______________________________ Phone 1: _______________ Phone 2: _____________ Parent/Guardian Name_______________________________ Phone 1: _______________ Phone 2: _____________ Medical Information Doctor to be contacted when parents cannot be reached: Name Address Telephone _______________________________________________________________________________________________ Dentist: Name Address Telephone _______________________________________________________________________________________________ Health Insurance Provider: Name Address Telephone _______________________________________________________________________________________________ Does your child have special needs affecting participation in school activities?: Yes No Specify: _______________________________________________________________________________________ Does your child have allergies?: Yes No Specify: _______________________________________________________________________________________ Actions Taken: __________________________________________________________________________________ _______________________________________________________________________________________________ Emergency Contacts The child may be released to the person(s) signing this agreement or to the following with photo ID: Name Address Telephone Relationship _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Emergency contact(s) when parents cannot be reached: Name Address Telephone Relationship _______________________________________________________________________________________________ _______________________________________________________________________________________________ ____________________________________________________ Parent/Guardian Signature _____/_____/_____ Date ____________________________________________________ Owner/Director Signature _____/_____/_____ Date KRK/104/REV/03/11 Kids ‘R’ Kids Greenville 125 Verdin Rd Greenville, SC 29607 (864) 288-5455 Health Policies Medications will be given at 11:00 A.M. and 3:00 P.M. only. We require a note from the child’s doctor for administering any over-the-counter medication. The note must have the child’s name, weight, medication name and dosage to be given and must state that the child is not contagious. Prescription medication and nebulizers will only be administered with a doctor’s note and only if the child has to have it more than two times a day. The doctor’s note must state how many times the child has to receive the medication. If the label says twice a day, we will not administer it. We do not allow children with communicable diseases, diarrhea or temperature of 100.5 degrees or more in the center (per DHEC). The child is not permitted back into the center until he/she is without fever (without the aid of fever reducers) and no vomiting or diarrhea has occurred for 24 hours. If your child is at the center and has three or more episodes of diarrhea in one day, you will be notified to pick them up. Child must be picked up within one hour of Kids R Kids staff calling and informing parent of illness. All medication must be in its original container. When your child has their scheduled immunizations, we must receive an updated copy for their file (per DHEC). Any colored discharge from the eyes or nose may indicate an infection. We request that you consult your physician before bringing your child to the center if this is present. We encourage you to help your child wash their hands every morning when they come into the center. By signing, I state that I have read, understand and will comply with the above regulations. _____________________________________________________ Child’s Full Name _____________________________________________________ Parent Signature _______________________ Date Kids ‘R’ Kids Greenville 125 Verdin Rd Greenville, SC 29607 (864) 288-5455 Bus Rules Every child must wear a seat belt at all times while on the bus. No standing on the bus is allowed at any time. The bus driver will notify the children when they are allowed to take their seat belt off and depart bus. No loud voices or screaming will be allowed. No child will be allowed to hang out of the windows of the bus. Hands, arms, head, etc. must remain inside at all times. No food, gum, candy or drinks will be allowed on the bus. No throwing of any objects will be allowed on the bus. Pencils, markers, etc. are not allowed to be taken out of back packs. Kids R Kids reserves the right to suspend any child from the bus if behavior warrants it. This includes any field trips. If your child misses a trip due to behavior there will not be a refund for the trip. We pay in advance for all trips. For the safety of the children and bus drivers, these rules must be followed at all times. _____________________________________________________ Child’s Full Name _____________________________________________________ Parent Signature _______________________ Date Distribution Child’s File Transportation Log Transportation Agreement The following information is required by Kids ‘R’ Kids annually Child’s Full Name: _____________________________________________ Date of Birth ___/___/___ Kids ‘R’ Kids #_____ emergency transportation/medical procedure: 1. Call emergency medical team, if necessary 2. Call parent/guardian 3. Call alternate emergency contact, if necessary 4. Emergency medical team transports child to hospital, if necessary 5. Kids ‘R’ Kids representative will accompany child to hospital. Emergency Medical Facility the center uses: _____________________________________________________________________ Address__________________________________________________________________________ Phone ___________________ I, ______________________________give permission for Kids ‘R’ Kids #____ to seek medical attention and /or transport my child_____________________________________, in the event of any emergency if I cannot be reached. I further agree to hold harmless and release Kids ‘R’ Kids _________and Kids ‘R’ Kids International, Inc. from all liability. I further agree to keep the facility informed of any changes in the information above. For School Age Use Only: If the child relocates to another school or the hours change, this form must be updated Name of School: _______________________________________________________________________________ School Address: ________________________________________________________________________________ School Phone: _________________________________________________________________________________ In the event the designated location is unable to receive children they will be returned to Kids 'R' Kids # ____. It is vital that Kids ‘R’ Kids # ____ be notified of any changes in the above scheduled transportation. Kids ‘R’ Kids # ______ will assume the above schedule of transportation will be followed unless we receive different instructions from parents. Instructions should be received at Kids ‘R’ Kids # ______ by the earliest possible time. I, _________________________________________________ agree for my child to be transported by Kids 'R' Kids #_______ To school at _____________ (am/pm) From school at ___________ (am/pm) On the following days: Monday Tuesday Wednesday Thursday Friday _________________________________________ _____/_____/_____ Parent/Guardian Signature Date __________________________________________ _____/_____/_____ Owner/Director Signature Date KRK/107/REV/03/11 Kids ‘R’ Kids Greenville 125 Verdin Rd Greenville, SC 29607 (864) 288-5455 Watch Me Grow Parent Acknowledgement Form About Watch Me Grow: Your childcare center offers Watch Me Grow streaming video which provides families with the opportunity to view their children online and share in their day. If you would like more information about Watch Me Grow please contact your center Director or visit Watch Me Grow online at www.watchmegrow.com. Watch Me Grow Acknowledgement: I acknowledge that my center has entered into an agreement with Watch Me Grow to provide authorized parents with internet access to streaming video of their children’s classroom and that my child’s classroom is included in this agreement. ___________________________________________________________________ Your name Your signature Date ___________________________________________________________________ Your name Your signature Date Kids ‘R’ Kids Greenville 125 Verdin Rd Greenville, SC 29607 (864) 288-5455 Photo Release I hereby assign and grant to the photographer, or those for whom the photographer is acting as indicated above, the right and permission to copyright and/or use and/or publish, and republish, photographic pictures and portraits of the minor named below in which said minor may be included in whole or in part, in color or black and white, made through any media by the photographer at his studio or elsewhere, including the use of any printed matter in conjunction with such photographs. I hereby waive my right to inspect and/or approve the finished photograph or advertising copy or printed matter that may be used in conjunction with such photographs, or to the eventual use that it might be applied. I hereby release and discharge the above, its assigns, and all persons acting under its permission or authority or those for whom it is acting, from and against any liability as a result of any distortion, blurring, alteration, or optical illusion that may occur in the taking of the picture, or processing or reproduction of finished product. I hereby warrant that I am of full age and competent to contract for the minor named below in so far as the above is concerned. I have read the foregoing release and warrant that I fully understand the contents thereof. _____________________________________________________ Child’s Full Name _____________________________________________________ Parent Signature _______________________ Date Kids ‘R’ Kids Greenville 125 Verdin Rd Greenville, SC 29607 (864) 288-5455 Discipline Policies The use of physical punishment or harsh language is prohibited at our center. No corporal punishment will be used at any time. This includes physical discipline, verbal abuse, humiliation or isolation. Discipline will consist of positive guidance techniques and Kids R Kids SC#1 will use these as follows: Infants and Toddlers (children under the age of two years): Encouraging, redirection, prevention and explaining. Time out or punishment should never be used with infants and toddlers. Preschool age children and school age children: Encouraging, redirection, prevention, explanation and problem solving. Time out may be used if necessary, and is limited to one minute per year of the child’s age with of maximum of five minutes. It will consist of the child being placed in a chair and never isolated from the group. I, _______________________________________________, understand the discipline procedures of Kids R Kids SC#1, as listed above. _____________________________________________________ Child’s Full Name _____________________________________________________ Parent Signature _______________________ Date South Carolina Department of Social Services Child Care Regulatory Services GENERAL RECORD AND STATEMENT OF CHILD’S HEALTH FOR ADMISSION TO CHILD CARE FACILITY This form is to be completed for each child at the time of enrollment in the child care facility, updated annually thereafter, and maintained on file at the facility. GENERAL INFORMATION: (to be completed by Parent or Guardian) Name of Facility: Address: County: City, State, Zip Street Address – no Post Office Boxes Child’s Name: Last First Middle Initial Date of Birth: Nick Name Enrollment Date: Child’s Current Home Address: Street Address City, State, Zip Parent/Guardian’s Full Name: Home Phone: Work Phone: Other Phone: Work Phone: Other Phone: Parent/Guardian’s Full Name: Home Phone: You must have two individuals who have the authority to obtain emergency medical treatment for the child. 1. Person responsible if parent/guardian unavailable for emergency medical services: Full Name Address: Relationship City, State, Zip Street Address Telephone Number(s): Family Code Word(s): 2. Person responsible if parent/guardian unavailable for emergency medical services: Full Name Address: Relationship City, State, Zip Street Address Telephone Number(s): Family Code Word(s): Is Child currently enrolled in school? (5K up to 6 years old) Yes My Child will regularly attend this facility FROM am/pm TO If Child is a drop-in, indicate hours of care: FROM Check all days Child will regularly attend this facility: Check all meals Child will receive daily: Afternoon Snack Dinner No am/pm am/pm TO Mon Tue Meals are not offered am/pm Wed Thurs Fri Sat Breakfast Morning Snack Evening Snack HEALTH INFORMATION: (to be completed by Parent or Guardian) Family Physician or Health Resource: Street Address Emergency Care Provider: Street Address DSS Form 2900 (OCT 07) Edition of MAR 94 is obsolete. Name City, State, Zip Telephone Emergency Facility Name City, State, Zip Telephone Sun Lunch Dental Care Provider: Name Street Address City, State, Zip Telephone Health Insurance Provider: Certificate of Immunization: Yes No N/A Please explain: My child has the following health conditions such as allergies, asthma, diabetes, epilepsy, etc., and/or takes the following medications on a regular basis: Additional Comments: I certify that to the best of my knowledge Child’s Name is in good mental and physical health and able to participate in the child care program at Name of Child Care Facility Signature: Signature: DSS Form 2900 (OCT 07) Date: Parent or Guardian Director/Operator/Staff Designee PAGE 2 Date: Distribution • Child’s File • Front Desk Forms Child File Checklist Check the box only after the information is completed, signed by all applicable persons and placed in file. Child’s Name: __________________________ Date of Enrollment: ___/___/___ Required State Forms Abide by State Licensing Standards for all required forms □ □ □ □ □ □ □ □ □ □ Kids ‘R’ Kids Forms □ □ □ □ □ KRK/101/REV/03/11 SCHOOL POLICIES AND PROCEDURES ►►►CHILDREN SERVED: Kids ‘R’ Kids Schools of Quality Learning are open to children ages 6 weeks to 12 years old without discrimination on the basis of political affilia‐ tion, religion, race, color, sex, mental or physical disabilities. ►►►SCHEDULE: Hours of Operation are Monday through Friday from 6:30am to 6:30pm. Kids ‘R’ Kids Schools of Quality Learning are open to you, the parent, any time your child is present in the school. For the safety of all children, we do request that you make your presence known to the person in charge, and cooperate in not disrupting the Center’s program. Kids ‘R’ Kids operates 12 months a year except for the following holidays which are observed even if the holiday falls on a weekend: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day plus the Friday after Thanksgiving, Christmas Eve (1/2 day), and Christmas. Kids ‘R’ Kids Centers are licensed for specific hours of operation, early arrival and late pick‐up cannot be allowed. If children are left at the Center after closing time and no word is received from the parent(s), or an emergency contact cannot be reached, authorities will be contacted as re‐ quired by law. After 6:30 p.m. there is a late pick‐up fee of $15 and an additional $5 for every 5 minutes thereafter. ►►►NUTRITION: Breakfast, lunch, morning and afternoon snacks are provided by our onsite nutritionist/cook. Our menus change from time‐to‐time and can be obtained at the center or via the center’s website. Please notify us regarding special diets and allergies. For bottle‐fed children, parents must provide prepared formula, placed in bottles. Kids ‘R’ Kids provides baby food. All infant items should be marked with the child’s first and last name. ►►►TUITION AND PAYMENT POLICIES: Our published weekly tuition rates are based on annual rates to be paid over 52 weeks, and can be paid in advance on monthly or annual terms (not discountable). Because your tuition is based on an annual rate, you must pay whether your child attends or not with the following excep‐ tions: If your child is present zero days within a calendar week (Mon – Fri), as a courtesy to our parents, we allow payment of half the weekly tui‐ tion rate for that week only (this discount is subject to a one [1] per calendar year limit and cannot be taken as part of notice period if dis‐ enrolling). After one full year of enrollment, you are allowed one free week (“vacation”) per calendar year where the child does not attend to be taken in five consecutive days, Mon. – Fri. Account must be current. Dis‐enrollment: You may dis‐enroll your child at any time with the limitation of a paid two (2) calendar week notice in writing so that we arrange another child to take your spot for the remainder of the year. You will be liable for two weeks (Mon – Fri) payment from the time you provide the written notice to Kids R Kids. Vacation week cannot be taken as part of notice period if dis‐enrolling. Late Fees: If balance is not paid by Tuesday a $10 late fee will be charged. If not paid by Thursday then an additional $10 late fee will be added. Non‐Payment: After one week of non‐payment, child will not be allowed to return until account paid in full (including late fees). After two weeks of non‐payment, child is dis‐enrolled & account is turned over for collection. NSF Checks: If your check is returned for any reason a $30 NSF fee will be charged. Late fees will also be charged back to original tuition due date. Multiple NSF checks will result in account being converted to cash only. ►►►OTHER POLICIES AND PARENT RESPONSIBILITIES: All enrollment forms & your child’s immunization record must be provided by the parent or child cannot begin our program. Please label all clothing with your child’s name and leave two changes of clothes at center at all times. Please do not allow your child to bring candy, gum, or toys to school unless specifically requested by the teacher. If your child does not adjust to our program, we reserve the right to promote, demote, or withdraw the child at any time. We do not allow children with communicable diseases, diarrhea or temperature above 100.5 degrees in the center (state law). A doctor note may be required to return. www.krkgreenville.com Parent/Guardian Signature:__________________________________
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