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
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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
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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):
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Encouraging, redirection, prevention and explaining.
Time out or punishment should never be used with infants and toddlers.
Preschool age children and school age children:
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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
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Kids ‘R’ Kids Forms
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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:__________________________________