caldera form Name Welcome Thank You for Choosing Little Ivies Prep! We are delighted to have you and your child become a part of the Little Ivies family There are several forms that make up the Little Ivies enrollment packet to complete your child’s file and the admissions process. This packet also includes a child health statement form that must be completed by a doctor prior to every child’s first day and updated annually in addition to all immunization guidelines. This packet must be completed and be in our possession before we can assume the responsibility of caring for your child. This ensures that your child receives the very best care possible and satisfies the record keeping requirement of state licensing guidelines. Should you have any questions please do not hesitate to contact us GET TO KNOW YOUR CHILD Q & A 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. PERSONALITY 1) Describe something your child loves to do? * 2) What words would you use to describe your child? * 3) When you child is upset, what calms him/her down? * 4) How does your child respond to new situations? * SLEEPING HABITS 1) What time does your child normally wake up? * 2) What time does your child normally go to bed? * 3) Please describe his/her sleeping habits? * Sleeps through the night Fussy throughout the night Takes Naps Easily Does Not Like Naptime EATING HABITS 1) What is your child’s favorite food at the moment? 2) What is their least favorite food? * 3) For snack what does your child like to eat: * 4) Please describe your child’s eating habits? * Healthy appetite ☐ Big eater Picky Eater ☐ Likes to nibble 5) For infants Please tell us what his/her normal feeding times are, we know this may not be exact so approximate times are fine * HEALTH QUESTIONS 1) Does your child have allergies? Yes No If yes, please specify to which food and/or medications he/she is allergic and what his/her reactions are when they are taken. 1) 2) 3) 2) Does your child having any of the problems listed below? a) Asthma * Yes No b) Frequent skin rashes * Yes No c )Heart trouble Yes No d) Diabetes * Yes No e) Frequent colds * Yes No f) Shortness of breath Yes No g) Speech problem Yes No h) Others (If not listed above, please explain.) * 1) Does the child live with both parents? * Yes No If not which parent is the primary or what is the relationship of the guardian? Click or tap here to enter text. 2) Is the child currently attending a day care program, play group, or independent school? Yes No If Yes, Please List 3) Are any other languages besides English spoken at home? Yes No If Yes, Please List Please describe any additional information you would like to make us aware of in the space below EMERGENCY CONTACT INFORMATION DATE OF BIRTH: * 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. 1) Name: 2) Name: 1) Phone# 2) Phone# 1)Relation: 2)Relation: PARENT/GUARDIAN #1 Print: * Signature: Date: * PARENT/GUARDIAN #2 Print: Signature: Date: PICKUP AUTHORIZATION FORM CHILDS NAME: * DATE OF BIRTH: a) Our school policy requires that children be picked up by parents. For a child to be released to anyone other than the parents, We require prior authorization be on file and ID be presented at the time of pick up. Under NO circumstances will the child be released to anyone other than those listed below without written permission from the parent b) The following people HAVE permission to pick-up the child named above from Little Ivies Prep. c) It is the parent’s responsibility to notify Little Ivies in writing of any changes to this list. 1) Name: 1) Relation: * 1) Phone: * 1) Address: * 2) Name: * 2) Relation: 2) Phone: * 2) Address: PARENT/GUARDIAN #1 Print: * Signature: Date: PARENT/GUARDIAN #2 Print: Signature: Date: INFANT FEEDING SCHEDULE & AGREEMENT CHILDS NAME: * DATE OF BIRTH: * Please choose one of the following options for your infant: * Breast Milk OR Formula While under Little Ivies care my child will be using Breast Fed Infants Only I understand that parents must provide Breast Milk daily I understand that breast milk must be measured and labeled with child’s first name My child is to be given ________ ounces of breast milk, Every _______hours Formula Fed Infants * I agree to provide all Formula for my infant child AND the Formula brand name is OR * I give Little Ivies permission to prepare formula based on package instructions My child is to be given ________ ounces of breast milk, Every _______hours For Infants Eating Solids My child is currently eating solids * Yes No I agree to provide ALL Solid foods for my infant child * Yes No I give Little Ivies permission to warm solid food * Yes No My child is to be given solid foods times per day PARENT/GUARDIAN #1 Print: * Signature: * Date: PARENT/GUARDIAN #1 Print: * Signature: * Date: SLEEPING & NAPPING ARRANGEMENT CHILDS NAME * DATE OF BIRTH: * xzvvb I, understand that my child, while under the care of LITTLE IVIES PREP will be napping on a crib OR cot within one the designated classrooms of the child care facility My napping child will have competent supervision at all times through, direct supervision by a caregiver who is in the same room and has direct visual contact with him/her OR an electronic monitor as an indirect means of supervision while my child is napping. If my child is an infant, I also understand that my child will be placed on his/her back to sleep If my child does not take a nap, he/she will be allowed to participate in a quiet activity during the napping period PARENT/GUARDIAN #1 (Print): (Signature): Date: PARENT/GUARDIAN #2 (Print): (Signature): Date: OUTDOOR & FIELD TRIP PERMISSION SLIP 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. PARENT/GUARDIAN #1 (Print): (Signature): Date: PARENT/GUARDIAN #1 (Print): (Signature): Date: * PERMISSION TO APPLY SUNSCREEN OR TOPICAL OINTMENT TO CHILD CHILDS NAME: * DATE OF BIRTH: Permission As the parent or guardian of the above child, I give permission for personnel at LITTLE IVIES PREP to apply a sunscreen product of SPF‐15 or higher and other topical ointments as necessary For medical or other reasons, please do not apply sunscreen or topical ointments to my child PARENT/GUARDIAN #1 (Print): (Signature): Date: PARENT/GUARDIAN #2 (Print): (Signature): Date: PARENT ACKNOWLEDGMENT FORM CHILDS NAME: * DATE OF BIRTH: RECEIPT OF PARENT HANDBOOK - 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. CONSENT TO EMERGENCY MEDICAL TREATMENT - 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 PHOTO/VIDEO/AUDIO RELEASE - 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. PARENT/GUARDIAN #1 (Print): (Signature): Date: PARENT/GUARDIAN #2 (Print): (Signature): Date:
