If Yes please list or describe:
No Slots Available!
TB Tests are at the physician’s discretion. Acceptable tests in+clude Mantoux or other federally approved test. If possible,
or if x-ray ordered, attach physician;s statement documenting treatment & follow-up
If the child has not been tested for lead, the day care provider may not exclude the child from child day care, but must give
the parent information on lead poisoning & prevention, & refer the parent to their health care provider or the county health
department for a lead blood screening test.
Are there allergies? (Specify)
Is medication regularly taken?
(specify drug & condition)
Is a special diet required? (specify diet & condition)
Are there any hearing, visual or dental conditions
requiring special attention?
Are there any medical or developmental conditions
requiring special attention?
Include special recommendations to child day care providers.
On the basis of my findings as indicated above & on my knowledge of the named child. I find that
he / she is freefrom contagious & communicable disease & is able to participate in child day care.
Public Health law section 2164 allows a child to be religiously exempted from immunization. A written & signed statement froma parent, parents or guardians of the child stating that they object of the immunization of their child due to their sincere and genuine
religious beliefs should be submitted to the day care owner, operator or administrator who shall determine whether the statement of religious belief is acceptable.
Parents are always the first to be called should an emergency occur, but we ask that you also provide us with the name of 2
relatives or friends to be called in the event you cannot be reached.
There are several forms that make up the Little Ivies enrollment packet. Please use this checklist to help complete your child’s file and the admissions process. All forms must be in our possession before we can assume the responsibility of caring for your child. This is to ensure that your child receives the very best care possible and satisfies the record keeping requirement of state licensing guidelines. Some forms Must be renewed annually.
Little Ivies Prep, LLC agrees to provide daycare and educational services in accordance with NYSOCFS guidelines for the 2019/20 school term. I, the undersigned, agree to pay Little Ivies Prep for services provided to my child as outlined in the below Tuition and Fee Schedule.
I understand that a Non-Refundable and Non-Transferable fee of $150 per student is due and payable at the time of registration.
A security deposit in the amount of $ 3300.00 is due and payable at the time of registration to secure your child’s enrollment at Little Ivies Prep. The deposit will be equal to one month’s tuition + annual fees and will be applied to the child’s first month.
The Security Deposit Will Not Be Refunded
Tuition Rates for the 2018/19 School Term (Monday thru Friday 8am to 6pm) are as follows:
I understand that the full month’s tuition is payable, regardless of sickness, vacations, school or statutory holidays as well as snow days or closings suggested by the mayor and regardless of my child’s absence from Little Ivies Prep for any reason.
Parents in need of late pick-up can do so for an additional fee
An annual technology and materials fee in the amount of $350 is applied to each student and must be paid at the time of enrollment and contract renewal
Choose your preferred payment method:
I understand that tuition is due and payable on the 5th day of the preceding month and that a $25 late fee will be assessed on any month payment is not received by the due date. Only in such events that advanced notice is given to the director prior to the due date will the fee be waived.
I further understand tuition payments are subject to a $30 charge for checks and payments that are returned due to insufficient funds.
If tuition is in arrears by 30 days or more, child(ren) may be dismissed from the school until all accounts are brought up to date or alternative payment arrangements are agreed upon by both parties.
When enrolling; children are expected to remain in the Little Ivies program for the contract term of (12) months. Should a family choose to withdraw their child from the program early, (60) days written notice to the director is required.
If an enrolled student withdraws for any reason with proper notice during the contract year, the current and following (2) month’s charges are still due. No tuition will be pro-rated and No credits or refunds will be given.
If for any reason a child(ren) is/are withdrawn without the proper notice, I understand that no credits will be given and the remaining contract months are still considered due and payable.
Should an enrolled student withdraw prior to the first day of school, the security deposit including technology and registration fees are NON-Refundable.
In consideration thereof, and not withstanding any other terms and conditions of this agreement, I agree to be liable for payment based on the chosen options of the school program, to be paid within the first five days of the preceding month, for the complete term of the contract, regardless of program attendance, subject only to the program’s Policy on Withdrawing from Preschool, stated in this packet.
I/We the undersigned have read and understood all policies.
Please fill out the questionnaire below as much as you can, so that we can learn more about your child’s personality, routines at home and any medical needs your child may have. Being that children spend a large part of their day with us it is important that we understand as much about their home life as possible. All information about your child will be kept confidential and at no time will this information be released to anyone.
If yes, please specify to which food and/or medications he/she is allergic and what his/her reactions are when they are taken.
In the interest of the all-round development of your child, we seek your permission to take your child on nature walks, the local parks as well as field trips in the neighborhood when the weather permits. Please sign and return the permission slip indicating acceptance.
I grant permission for my child,
to go on outings and or field trips that require him/her to leave the school premises.
I have accessed the 2019/2020 Little Ivies Parent Handbook detailing school policies, regulations and procedures for all students and families via the school’s website www.littleivies.nyc. I acknowledge that I have read and am familiar with the policies and regulations set forth in the Parent Handbook. In addition, I understand that the contents of the Parent Handbook are subject to change and that any such revisions will supersede, modify, or eliminate the current contents of the Parent Handbook.
Little Ivies Prep has my consent to secure and authorize emergency medical treatment or hospitalization in the event of an accident or illness involving my child while under its supervision that, is necessary and in the best interest of my child. This authorization is granted only after a reasonable effort has been made to contact me. I understand that this written consent is given in advance of any specific diagnosis or hospital care. I agree to assume and pay for the fees for the emergency medical treatment as authorized in this statement.
Little Ivies Prep has my consent to make (or authorize the making of) a photograph or videotape of my child or his/her work for any lawful purpose without further notice to me. I understand that such photographs, videotapes, or audiotapes of my child, which may not be accompanied by his/her name, could appear on the school’s Website on the Internet with or without my knowledge. I further understand that my child’s work, which may be accompanied by his/her name, may be electronically displayed and produced.
I have read, understand and agree to the above policies and conditions.
Please bring the items listed below on your child’s first day of school. REMEMBER to Label all items with your child’s name.
Little Ivies520A West End Ave New York, NY email@example.com
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