2015-16 MOPPETS Registration Form Please fill out one form per child Mother’s Name: _________________ Child’s First Name:_____________ Child’s Birthday: ________________
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Last Name: _____________
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WHO HAS PERMISSION TO PICK-UP THIS CHILD IN CASE OF EMERGENCY? (PLEASE LIST AT LEAST TWO CONTACTS) Emergency Contact 1 Name: ______________
Relationship to child: ______________
Phone Number: _________________
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Emergency Contact 2 Name: _________________ Phone Number: _________________
Relationship to child: ________________
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TELL US A LITTLE ABOUT YOUR MOPPET: Siblings: Name: ______ _____ _ Name: __________
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Age: ______ Name: ___ ___
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Age: ______ Name: _______________
Age: ______ Age: ______
FAVORITE TOY, SONGS, GAMES: _
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ALLERGIES: _
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SPECIAL NEEDS AND INSTRUCTIONS: _
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Christus Victor Lutheran Church MOPS ~ 1045 S Arlington Heights Rd, Elk Grove Village, IL 60007
Policies for MOPPETS 2015 – 2016 MOPPETS welcomes children, ages 6 weeks through 6 years old. A parent or guardian of the child(ren) must remain on site with the MOPS group until the child is picked up. Infants will remain with moms. The 1-2-year olds will be cared for with a very flexible program in the nursery. The 3-5year olds will learn about God’s love through singing, free play, arts and crafts, and games. Please leave outside toys at home, and electronic devices will not be allowed in the childcare rooms. A snack will be provided for your child while at MOPPETS. This year, we will serve water and half a cut-up banana for the 1-2-year olds. Water and Honey Teddy Grahams and Goldfish will be provided for the 3-5-year olds. If your child has allergies, please notify his/her teacher and provide an alternate snack. Each child must bring his/her own diapers, bottles, and sippy cups. (Again, please leave outside toys and electronic devices at home.) Please label everything that comes in with your child. Childcare providers will change diapers, as needed, unless another agreement has been arranged with the parent or guardian. MOPPETS childcare is equipped to provide care for children who are well. If your child has been sick, please refrain from bringing them to MOPPETS until they have been fever-free, vomit-free, and have not had a loose stool for at least 24 hours. There are too many little bodies that are put at risk! Thank you for your cooperation in this matter. For some children, it will take time to grow comfortable in the childcare setting. If the parent or guardian feels the need to help the child acclimate by being present with their child in the childcare room, they will be allowed to do so for a short while. However, since all childcare providers have been background checked – and many are equipped with CPR training – the parent or guardian must only be present for his/her child and refrain from assisting in the care of other children during that brief acclimation period while in the room. Cameras and phones with cameras are not allowed in the childcare rooms, and absolutely no Facebook postings shall be made of MOPPETS children, even to “friend” groups. Occasionally, a photographer will come in to take pictures for advertising purposes, but you will be notified and asked permission beforehand. Please sign your child(ren) in and out, when dropping them off at 9:30 and picking them up at 11:15, so that we may ensure safety for all involved. I HAVE READ AND UNDERSTAND THE MOPPETS POLICIES OF MOPS. Member Signature: _________________________________
Date: ___________________
Christus Victor Lutheran Church MOPS ~ 1045 S Arlington Heights Rd, Elk Grove Village, IL 60007
