Children’s Garden 2018-2019 School Year Registration Forms must be completely filled out in order to be processed ~ Please Print ~ Black or Blue ink

Child’s Name ______________________________________________________________________ (first)

(last)

Primary Parent Or Guardian ______________________________________________________________________ (first)

(last)

Latchkey Elementary School ________________________________

Grade ________ 2018-2019

Please select ONE of the following AM Latchkey options and circle days needed: AM Latchkey ~ 6:30 - 9:00 AM
2 days per week

M T W TH F

$64 per 4-week session


3 days per week

M T W TH F

$97 per 4-week session


4 days per week

M T W TH F

$130 per 4-week session


5 days per week

M T W TH F

$162 per 4-week session

Please select ONE of the following PM Latchkey options and circle days needed: PM Latchkey ~ Dismissal - 6:00 PM Anderson/McGrath, Brendel, Cook/Mason, Indian Hill, Myers, Reid, Preschool
2 days per week

M T W TH F

$70 per 4-week session


3 days per week

M T W TH F

$104 per 4-week session


4 days per week

M T W TH F

$138 per 4-week session


5 days per week

M T W TH F

$172 per 4-week session

Extended PM Latchkey ~ Dismissal - 6:00 PM Perry Innovation Center
2 days per week

M T W TH F

$78 per 4-week session


3 days per week

M T W TH F

$116 per 4-week session


4 days per week

M T W TH F

$156 per 4-week session


5 days per week

M T W TH F

$196 per 4-week session

Preschool st

Child’s Age as of December 1 , 2018:


3 years


4 years


5 years

AM Preschool ~ 9:00 - 11:30 AM Please select ONE of the following AM Preschool options:
2 days per week (Tuesday & Thursday)

$115 per 4-week session


3 days per week (Monday, Wednesday & Friday)

$175 per 4-week session


5 days per week (Monday through Friday)

$290 per 4-week session

Lunch Time Care (Full Day Students Only) ~ 11:30 - 1:00 PM Please select ONE of the following Lunch Time Care options:
2 days per week (Tuesday & Thursday)

$44 per 4-week session


3 days per week (Monday, Wednesday & Friday)

$65 per 4-week session


5 days per week (Monday through Friday)

$110 per 4-week session

PM Preschool ~ 1:00 - 3:30 PM Please select ONE of the following PM Preschool options:
2 days per week (Tuesday & Thursday)

$115 per 4-week session


3 days per week (Monday, Wednesday & Friday)

$175 per 4-week session


5 days per week (Monday through Friday)

$290 per 4-week session

Children’s Garden  11920 S. Saginaw St.  Grand Blanc, MI 48439  810-591-6083  FAX 810-591-6095

Children’s Garden Data Sheet State of MI Licensing requires that forms be completely filled out in order to be processed. If the information is not known or does not apply, “unknown” or “none” is the required response. A blank field, a line through a field or “N/A” are not acceptable responses. Date of Admission (office use only) Date of Discharge (office use only) Please Print

Child Information Child’s First Name

Child’s Last Name

Sex M F

Allergies, if any

Home Address (Number and Street)

City

Child’s Date of Birth

Primary Email Address

Primary Phone # ( )

State

Zip

Parent/Legal Guardian’s Name (1st contact)

Parent/Legal Guardian’s Name (2nd contact)

Location when child is in school (Name of Employer/School, home, etc.)

Location when child is in school (Name of Employer/School, home, etc.)

Address (Number and Street)

Address (Number and Street)

City

State

Zip

City

State

Cell # (

)

Cell # (

)

Work # (

)

Work # (

)

Zip

Two local contacts, other than parent, to be notified in case of an emergency when parent is not available Name

Relationship to child

Address (Number and Street)

City

Name

Relationship to child

Address (Number and Street)

City

Home # ( Cell # ( Work # ( State

) ) )

Home # ( Cell # ( Work # ( State

) ) )

Zip

Zip

Names of persons other than parent to whom child may be released ~ must have at least 2 names (may be same as above)

Name

Relationship to child

Name

Relationship to child

Name

Relationship to child

Name

Relationship to child

Medical Information Name of child’s Physician or Health Clinic

Office Hours

Phone # ( )

Address (Number and Street) City

State

Zip

Hospital preferred for Emergency Treatment

Family Unit Child Lives With:  Mother Only  Both Parents

Dominate Language in Home  Father Only  Legal Guardian

Siblings: Names and Ages

In case of separated or divorced parents, are there any legal restrictions on the release of the child?

Court Papers are required for any legal restrictions. Are there any restrictions on your child’s activities in school? If so, what?

Does your child have any special likes or dislikes that we should know about?

I certify that I accurately completed this form and if anything changes, I will notify Children’s Garden by updating this form. Parent/Guardian Signature ___________________________________

Date ____________

Children’s Children’s Garden Dear Parents: To avoid misunderstandings regarding our policies, we ask you read the following information and then sign the bottom portion. Also, please read the Parent Handbook provided. Absences - Due to staffing requirements by our state license and according to the proportion of scheduled students, absences will not be deducted from the 4-week session. Bathroom Independence - Children must be able to use the bathroom independently. Pull-ups are prohibited. Children’s Garden does not have an infant license; therefore our staff is unable to assist with bathroom use. Please make sure your child is wearing clothing they can easily get in and out of without assistance. If they are not completely bathroom independent they may not be ready for preschool at this time. Emergency Numbers - Parents must leave a current and working phone number where they can be reached, as well as two additional names and telephone numbers to call in the event the parents cannot be contacted. If your phone number changes or any other information changes, please notify the office immediately. Failure to do so may result in dismissal from our program. Enrollment - Our center is open to any child, 3 years old on or before Dec. 1st (completely bathroom independent) thru elementary school, providing space is available and the center can meet the needs of the child. Medical records of the child’s immunization must be provided before attendance for all preschool children. This is mandated by the State of Michigan. The annual registration enrollment fee is nonrefundable; $50.00 for the first child, $25.00 each additional child. Family Rates - Family rates are available. The child with the highest tuition will pay full price. Each additional child will receive a 20% discount based on the number of days scheduled. Each child must use our program 3 or more days in order to receive discount. Full Day Preschool Students – Lunches, labeled with child’s name, need to be provided by parents for preschool children receiving full day care. Milk will be provided during lunch. Latchkey Attendance - So we can be accountable for all our students, parents must call their latchkey location if their child will not attend PM latchkey on a scheduled day. Parents must call the Children’s Garden Office/classroom or satellite no later than 4:00pm (3:00pm for City/Perry) on or before the day of the absence. Failure to do so will result in a $10.00 charge each time and may result in dismissal from our program. Your child’s safety and whereabouts is our #1 concern. Latchkey Conduct - Latchkey students will follow the elementary school rules, including no bullying, when they are in latchkey. Failure to comply will result in dismissal from our program. Late Pick-Up - Charges will be assessed for late pick-up. If a child is not picked up by the dismissal time of their program, a late pick-up fee of $10 per quarter hour will be assessed. Habitual abuse of this practice or non-payment of assessed fees may result in dismissal from program. Nap Room - Preschool children are required to rest during the day if they are at the center for a full day program. They will be returned to class at the start of their scheduled class time, if awake. Sleeping children will be awakened at 2:00pm, at the latest, to be escorted to their afternoon class. Payments - Our center operates on a 4-week flat rate session system, not by the month. Pre-payment, prior to the 4 week session, must be made during the designated week of registration. Failure to do so will result in a $10.00 per day late fee. If we do not have payment by the Tuesday after the due date your child will be dropped from our program. You will have the opportunity to re-enroll ($25 re-enrollment fee) your child at the next registration period, providing there is availability. The days used in the 4-week session must be consistent. There are no refunds for scheduled days not used, including school activities, snow days, district days off, etc. Voluntary withdrawal by parents will not constitute a refund once the second week of the session has begun. Credit card payments are only accepted online using PaySchools (open only during designated registration/payment weeks) and are not accepted in the office. Playground Use -Your preschool/latchkey student will be occasionally using the elementary school playground which, in some areas, is designed for ages 5 through 12 years old. The equipment meets the standard and safety requirements for elementary schools. Schedule - We operate within the Grand Blanc school calendar. If the Grand Blanc Schools are closed due to holidays, inclement weather, mechanical problems, Records Day, PDD, etc., Children’s Garden will also be closed. This includes both latchkey and preschool programs. There is no refund for unscheduled school closings. Sign-In/Sign-Out - In both the preschool and latchkey programs, parents (or designated pick up person) must accompany their child/children to the appropriate classroom and sign their child/children in and out. Snacks - Daily snacks will be served to afternoon latchkey students. Preschool parents provide snack, including milk, cups, napkins and utensils (if necessary) on their designated day. Any child with special dietary needs must supply a daily snack by their own parent according to their physician’s recommendation. Transportation – It is Board Policy that your child is dropped off at the same location daily. Since Anderson, Myers & Indian Hill students are bussed to their PM Latchkey site, those who do not have a Monday - Friday PM latchkey schedule must be parent pick-up on the days they are not scheduled for PM latchkey. Vacation - If your child is absent due to a vacation, your family will be allowed one consecutive calendar week (Monday – Friday) of vacation credit per child’s schedule. You must notify the office and classroom teacher prior to the session registration you will be taking vacation.

I have read the above information, received the Parent Handbook and agree to abide by the policies and procedures therein.

Parent/Guardian Signature_____________________________________

Date______________ Version 2.7.2018

Version 2.7.2018

Children’s Garden The Licensing Division of the Department of Social Services requires that we have a statement from parents of all children in our program indicating the youngster is in good health and has no health related restrictions to participate in our program. Please check all that apply and complete the information below:

My child




is in good health and has no health related restrictions regarding participation in the Children's Garden Program. has the following restrictions regarding participation in the Children's Garden Program:




receives Special Education services and has an IEP or 504 on file with the school district. I give my permission for the Director, Preschool Teacher and/or Latchkey Teacher to obtain information, if needed, to meet the needs of my child.




Parent/legal guardian must INITIAL one of the following: _____ I give permission to Children’s Garden, licensed by the Department of Licensing and Regulatory Affairs to secure emergency medical and/or emergency surgical treatment for the above named minor child while in care. _____ I do not give permission to Children’s Garden, licensed by the Department of Licensing and Regulatory Affairs to secure emergency medical and/or emergency surgical treatment for the above named minor child while in care. I understand I assume responsibility for all emergency medical care.

Date

Parent/Guardian Signature

CONCUSSION AWARENESS EDUCATIONAL MATERIAL ACKNOWLEDGEMENT FORM IN COMPLIANCE WITH MICHIGAN PUBLIC ACTS 342 and 343 of 2012 By names and signatures below, we acknowledge in accordance with Public Acts 342 and 343 of 2-12 that we have received and reviewed the Concussion Fact Sheet for Parents and Students provided by Grand Blanc Community Schools and Grand Blanc Parks and Recreation __________________________________

__________________________________

Student or Participant Name Printed

Parent or Guardian Name Printed

__________________________________

__________________________________

Student or Participant Signature

Parent or Guardian Signature

Please return this signed form to the sponsoring organization or school. In compliance with the law, these forms must be kept on file for the duration of participation or until the student reaches the age of 18.

Participants/Students and parents: Please review and keep the educational materials available for future reference

Parent Notification of the Licensing Notebook Requirement Child Care Organizations Act, 1973 Public Act 116 All child care centers must maintain a licensing notebook which includes all licensing inspection reports, special investigation reports and all related corrective action plans (CAP). The notebook must include all reports issued and CAPs developed on and after May 27, 2010 until the license is closed. • This center maintains a licensing notebook of all licensing inspection reports, special investigation reports and all related corrective action plans. • The notebook will be available to parents for review during regular business hours. • Licensing inspection and special investigation reports from the past two years are available on the Bureau of Children and Adult Licensing website at www.michigan.gov/michildcare. I have read the above statement issued by Children’s Garden. Parent Name ________________________________________________ Parent Signature ______________________________

Date _________

I hereby give my child _____________________________________ permission to be included in photos/videos and participate in the field trips or any activities planned and supervised by Children’s Garden.

Parent/Guardian Signature______________________________ Date_________

Children’s Garden Thank you for choosing Children’s Garden and sharing your child with us. I understand that I have paid the necessary non-refundable registration fee(s) to hold my child’s/children’s space(s) for the fall 2018-19 school year. For the first session only, if I choose to make a change to my child’s schedule a $25.00 fee will be assessed for each time a change is made. Changes to the first session can only be made up until Friday, August 24th, 2018. • A tuition invoice will be sent to your home in August for the 1st session ONLY. All subsequent payment correspondence will be distributed through your child’s preschool or latchkey teacher. • A $50.00 non-refundable registration fee will hold your space for the fall. • A $25.00 non-refundable fee will hold a space for each additional child. • Check (made payable to Children’s Garden) and cash are the only forms of payment accepted for registration fees. • Future tuition payments can be made with a credit card but only online. • You must commit to a set schedule at the time of registration. Parent/Guardian Signature____________________________________ Date________________