Preschool Registration Form

Thank you for enrolling in the First Baptist Church Preschool.

Please complete the following enrollment forms.

The Preschool Director, Jaymie Shine, will contact you upon your submission.

Child's Information

Child's Name

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Address

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Birthdate

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Sex

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Parent/Guardian Information

Primary Parent/Guardian Name

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Primary Parent/Guardian Email

*

This address will receive a confirmation email

Primary Parent/Guardian Phone

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Primary Parent/Guardian Employment

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Secondary Parent/Guardian Name

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Secondary Parent/Guardian Email

*

Secondary Parent/Guardian Phone

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Secondary Parent/Guardian Employment

Who does the child live with?

*

Please select one option.

Both parents Legal guardian Mother only Father only

Program Choice Information

Program Choice

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Please select one option.

Morning - 2 day Morning - 3 day Morning - 5 day Afternoon - 2 day Afternoon - 3 day Afternoon - 5 day

School Year

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Please select one option.

Current (23-24) Next (24-25)

Are you a member or attend FBC on a regular basis?

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Please select one option.

Yes No

Emergency Contact Information

Please provide contact information for two emergency contacts. They will only be contacted if we are unable to reach the child's parents/gaurdians.

Emergency Contact 1 Name

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Emergency Contact 1 Phone Number

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Emergency Contact 2 Name

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Emergency Contact 2 Phone Number

*

Please provide us with name, address, and phone number of persons authroized to pick up your child. This is for those outside the parents/guardians who have permission to pick up your child.

Person 1

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Person 2

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Child's Personal Record

Name and ages of siblings

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Others living in household and relationship

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Describe any group experiences your child has had or is having now.

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What are your child's favorite indoor activities.

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What are your child's favorite outdoor activities.

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Do you have any pets at home? If so, what type(s) and name(s).

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Does your child have food allergies? If so, please explain.

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Does your child have any other medical issues or concerns? If so, please explain.

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Does your child have any fears? If so, please explain what they are and how you handle them.

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What concerns do you have about your child's present behavior. If none, please state that you do not have any concerns.

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Are there any special circumstances in the family, which may be a factor in your child's behavior? These include recent moves, death, new baby, divorce, etc. If so, please explain.

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In what way(s) would you like to see your child develop during their experience at our preschool?

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Please add any additional information that will help us know your child better.

*

Policies

Please read each policy and consent listed below. By typing your full name, you are agreeing that you have read and will abide the policies set forth by the First Baptist Church Preschool.

Emergency Medical Care
This authorizes the First Baptist Church Preschool to secure EMERGENCY medical care for my child when I/We cannot be immediately reached at the time of emergency. I/we understand that the school does not assume responsibility for the emergency medical charges and I/we pay charges upon receipt of the statement.

Child's Doctor name and phone number

*

Parent/Guardian Electronic Signature (Type Full Name)

*

TRIPS, EXCURSIONS, AND PUBLIC PARK FACILITIES
I/we authorize the First Baptist Church Preschool to take my/our child on walking trips, special excursions, and to nearby public park facilities. I/We understand all such trips are under the supervision of the above/named facility and that health and safety precautions are taken in compliance with DCFS standards for licensee.

Parent/Guardian Electronic Signature (Type Full Name)

*

RELIGIOUS INSTRUCTION
I/We understand that the First Baptist Church Preschool is a Christian-based school. I/We give consent for my/our child to participate in the religious teachings of the school. In participating, the child may sing Christian songs, hear Christian stories, do Christian finger plays, etc.

Parent/Guardian Electronic Signature (Type Full Name)

*

PICTURES OF CHILD
Does the the staff of First Baptist Church Preschool to have your permission to photograph your child for the purposes of art projects, room display, and any media related activities such as television/radio station coverage of an event?

Can we use photographs of your child for purposes stated above?

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Please select one option.

Yes, I authorize the staff of the FBC Preschhool to photograph my child for purposes stated above. No, I do not authorize the staff of First Baptist Church Preschool to take or use photographs of my child.

Parent/Guardian Electronic Signature (Type Full Name)

*

ILLNESS POLICY
If a child is listless, or cannot go outside for play, he/she should remain at home. Please contact the school is your child will be out due to illness. A child should not be sent to school with a fever. If there is any doubt regarding a communicable disease, the child should remain at home during the contagious period. If a cough persists for weeks, the child's physician should be contacted. If a child should become ill while at school, parents, or emergency numbers, will be called and the child will be isolated and allowed to rest on a cot. Teachers will not administer any medication, except for routine first aid on cut and scrapes. In the event of any serious injury, an accident report will be filed with the director and parents will be notified of the accident and how the injury was treated. Parents must sign the consent form stating that they have read the illness policy and agree to abide by this policy.

Here are the guidelines you should follow when deciding when your child should stay home and when they can return to school following an illness.

•FEVER-temperature of 100° F under the arm. May return when fever free for 24 hours.
•VOMITING-May return to school when vomit free for 24 hours.
•DIARRHEA-Free from diarrhea for 24 hours. The exception is if the child is on medication that causes diarrhea.
•CONJUNCTIVITIS-Unusual redness of eyelid lining, irritation followed by swelling and/or discharge. May return when on mediation for at least 48 hours or note from doctor stating child does not have conjunctivitis.
•CHICKEN POX-Known exposure, low grade fever, blister-like rash. Child may return to school when all pox are scabbed over.
•SKIN RASH-Yellowish, unusual or persistent rash, severe itching of body or scalp, potentially infectious skin patches that are crusty-dry, scabbed, weepy or gummy. Note from doctor that child is not contagious.

I/We have read and understand the illness policies of First Baptist Church Preschool as stated above and in the school’s handbook. I/We will abide by the guidelines for illness in deciding whether our child/ren are able to attend school for that day.

Parent/Guardian Electronic Signature (Type Full Name)

*

DISCIPLINE POLICY
“First Baptist Church Preschool abides by the regulations issued by the Department of Children and Family Services:

"No child shall be subject under any circumstances to corporal punishment inflicted in any manner upon the body or to verbal abuse, deprived of regularly scheduled meals as punishment, or punished for toilet accidents."

Time outs will be used if a child is out of control. The child's parents will be notified if a problem persists. Following any time of correction, the teacher will lead the child through appropriate steps to restore them with the class, the teacher and the Lord. This will usually be a short prayer of forgiveness and an opportunity to ask for forgiveness of anyone involved in the situation.

“Any child who, after attempts have been made to meet the child’s individual needs, demonstrate inability to benefit from the type of care offered by the facility, or whose presence is detrimental to the group, shall be discharged” (DSCFS 407.25j)

Parents must sign the consent form stating that they have read this policy and agree to abide by this policy.

I/We have read and agree with the discipline policy of First Baptist Church Preschool as stated above and in the school’s handbook. I/We understand that this policy follows the DCFS regulations.

Parent/Guardian Electronic Signature (Type Full Name)

*

Late Pick-up Policy
As stated in the First Baptist Church Preschool Handbook, all children are to be picked up at the end of the morning session by 11:40 am and the afternoon session by 3:10 pm.

In the event that your child remains in our care past this time, the following actions will be taken:

•Preschool staff will attempt to reach parent/guardian, and/or emergency contact until 12:00 pm for morning session and 3:30 pm for the afternoon session. The staff will continue to call and leave messages/voice messages and wait for a return call until the times stated above. A minimum of 3 calls will attempted during this time.
•At 12:00 pm/3:30 pm, if no contact has been made with the parent/guardian, or emergency contact, Preschool staff will contact local police. Preschool staff will remain with the child until authorities arrive and assume custody of the child regardless of time elapsed.
•Payment of $1.00 per minute will be charged to the parent/guardian following the 11:40 am & 3:10 pm times. This fee is due when the child returns to school at their next scheduled time.

Preschool Staff/Administration assumes responsibility for the following:

•Staff acknowledges responsibility for the child’s protection and well-being until the parent or authorities arrive and assume custody of the child.
•Staff will discuss the issue with the parent only, not with the child, and at a time in which the child is not present.

Parents/Guardian assumes responsibility for the following:

•Information regarding phone numbers by which to reach parent/guardian is to be kept current at all times. Immediate notification will be submitted to FBC Preschool of changes throughout the year.
•Emergency contact information (phone numbers, work location, etc.) must be kept current at all time. Should information change, parents are to submit this information to the preschool immediately.

I/We have read the above information and have asked for and received clarification regarding any portion that was unclear.

Parent/Guardian Electronic Signature (Type Full Name)

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Enrollment Agreement

After reading the policies above and providing enrollment information for my child, I hereby enroll my child in the First Baptist Church Preschool and agree to abide by its policies.

Parent/Guardian Electronic Signature (Type Full Name)

*

After submission of this form, the Preschool Director, Jaymie Shine, will contact you about your enrollment and current openings.

If you have any questions in the meantime, feel free to email her at jshine@savoychurch.org

Description

Thank you for enrolling in the First Baptist Church Preschool.

Please complete the following enrollment forms.

The Preschool Director, Jaymie Shine, will contact you upon your submission.

Please Fix the Following

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