Student Information
Program Selection
SUMMER CAMP T-SHIRT ORDER- $15 each
Medical/ Health Information
Parent #1/ Legal Guardian Information
Parent #2/ Legal Guardian Information
Prior School Experiences
Emergency Contact #1
Emergency Contact #2
Emergency Contact #3
PLEASE READ CAREFULLY
PARENT CONSENTS & ACKNOWLEDGEMENTS
● SUMMER CAMP PARTICIPATION- I, the parent/ guardian of the above-named child, hereby, consent to participating in the preschool summer camp sponsored by Pineview Preschools. I understand that my child will be participating in activities such as: water activities/ splash days, animal shows, outdoor activities such as soccer and other sports. To the best of my knowledge, my child is physically fit and able to participate. ● MEDICAL TREATMENT AUTHORIZATION- Pineview Preschools is authorized to obtain emergency transportation to and/or emergency medical care for the above listed child at the nearest hospital’s emergency room, or at the emergency room the EMS/Ambulance Service is required to transport patients to at the time of emergency. Pineview Preschools’ personnel and emergency personnel are authorized to provide CPR and First Aid to child. The parent agrees to pay all expenses incurred in connection with such emergency treatment. ● PHOTOGRAPH & VIDEO- At Pineview we document children’s experiences through the use still photographs, digital photographs, motion pictures, television transmission, and/or videotaped recordings (hereinafter “Recordings”) of parents, children, wards, and staff for educational, documentary, and public relations purposes. Any such Recordings may reveal you or your child’s identity through the image itself without any compensation to you, your children, or wards. All Recordings taken of you, your children or wards shall be the sole property of Pineview Preschools. Regarding the use of any Recordings taken of you, your children, or wards, you hereby waive all present and future claims you may have against Pineview Preschools, their staff, service providers, employees, agents, affiliates, and Board members. ● SOCIAL MEDIA- Pineview Preschools participates in social media and often post pictures and videos of school related activities. Therefore, pictures/videos of children and parents are posted on our schools’ social media. **IF YOU DO NOT WANT YOUR CHILD PHOTOGRAPHED OR VIDEO TAPED, PLEASE INFORM THE DIRECTOR IN WRITING. ● HEALTH FORMS: I understand I must provide the school with updated Physical and Immunization Records completed and signed by the child’s physician before the child’s first day at center and upon expiration date of forms: Section 65C-22.006(2), F.A.C., requires a: Statement of Good Health (Form #3040) and Immunization Record (Form #680). We only accept children who are immunized to ensure the safety of students and faculty. *If the date on the form becomes expired and new forms are not brought in, we cannot accept the child. ● CHILD CARE LICENSING FORMS: I have received copies of the following: Section 402.3125(5), F.S. Child Care Facility Brochure, “Know Your Child Care Facility” (CF/PI 175-24) also available at www.myflfamilies.com/childcare AND the “Influenza Virus, the Flu, A Guide to Parents” Brochure. ● GUIDANCE POLICY: Our guidance policy is not associated with food, drink, rest, or toileting and we do not tolerate physical punishment. Teachers avoid using punishment and reward as tools for managing children’s behavior. Teachers will encourage children to find a solution to the problem within the appropriate developmental expectations of each child. Section of 65C-22.001(8)(b) and (c) requires: (b) All childcare personnel must comply with the facility’s written disciplinary policy. Such policies shall include standards that prohibit children from being subjected to discipline, which are severe, humiliating, frightening, or associated with food, rest, or toileting. Spanking or any other form of physical punishment is prohibited for all childcare personnel. (c) Children may not be denied active play because of misbehavior. ● REFERRALS/ DEVELOPMENTAL DELAYS: As early childhood educators we are the first in line to see delays or any developmental issues. If it is determined that the child would benefit from a more diagnostic evaluation, a referral may be made to community agencies for speech/ language, physical, occupational, behavioral, family and/or mental health therapy. We reserve the right to terminate enrollment if the school is unable to meet the individual needs of a child or if early intervention is not provided for the child. ● PHYSICAL ACTIVITY: I understand that my child will participate each day in a variety of age-appropriate physical activities designed to achieve optimal health, wellness, gross-motor development, and fitness. Activities will take place both outdoors and indoors for a minimum of 60 minutes throughout the school day (typically 30 minutes in the morning and 30 minutes in the afternoon for children enrolled in an extended day program). Children will have water accessible to them throughout the day. Parents must dress their child in school uniform and provide a sweater/ jacket during cold weather. The most appropriate type of shoes for participation in all school activities are rubber-soled sneakers/ tennis shoes. *Infants will be provided with opportunities for play outside of cribs in addition to scheduled tummy time. ● SCHOOL CLOSURES/ ABSENCES: I have reviewed the school calendar with all holidays, teacher planning days and school closure dates. I understand that tuition is not pro-rated or credited for those closure days, vacation, or absences. During a health crisis or pandemic, the local Health Department may recommend quarantine periods and/or school closures to prevent an outbreak. *Tuition will not be credited, refunded, or prorated for any temporary closures, absences, or exclusion from the program. ● DROP-OFF & PICK-UP: Parents must sign in child upon drop-off and sign child out upon pick-up on the ProCare app in the lobby. It is every parent’s responsibility to sign their child in/out each day for security and safety reasons. I understand that I will be charged $1.00 per minute for the first 10 minutes that I am late picking up my child. The fee will increase to $2.00 per minute after the first 10 minutes that I am late. ● CHILD RELEASE: The School will release the Child only to parents and other person(s) the Parents designate in writing. The Parents will notify the school, in advance, in writing if someone other than those listed will be picking up the child. Any person, at any time may be required to provide valid photo identification to staff when picking up a child. **Parents must keep emergency contact information including phone numbers current. ● PEANUT AWARE POLICY: I understand our school is not “Peanut Free” but instead, “Peanut Aware,” and therefore as safe as possible for children with life-threatening nut/peanut allergies. Parents and students are not allowed to bring nut products to school at any time. While we cannot guarantee a peanut/tree nut-free environment, we are committed to making every effort to minimize the risk. ● SICK POLICY: Parents will abide by the “Sick Children” Policy including picking up child within 45 minutes of school contacting parent and not returning child to school until after the wait period as indicated in the Parent Handbook even if the doctor indicates child can return to school. ● COMMUNICABLE DISEASE: Parents will notify the school in writing if the Child contracts or is exposed to any communicable illness. ● CONFERENCES: Parents must attend conferences when requested. We reserve the right to terminate if parents refuse to attend conferences. ● PARENT CONDUCT: Parents or any other family member must always act respectfully while on school grounds. Parents will refrain from verbally or physically abusing staff, other children, or property. Parents must also take responsibility for any family member’s actions. Parents must also refrain from reprimanding or disciplining children of other families while on the school premises. ● PARENT HANDBOOK: I understand that it is my responsibility to read and comply with all school policies in the parent handbook available on the parent portal that include policies on child’s behavior, parent code of conduct, food, nutrition, food safety, and food allergens. ● RELEASE: I do hereby waive, release, absolve, indemnify, and agree to hold harmless Pineview Preschools, its owners, officers, and staff from all claims arising out of any injury to my child for any cause as a result of a third-party liability and acts of God.
Parent #1 Signature, Name, and Date
Parent #2/ Legal Guardian Signature, Name, and Date
Please upload both parents'/ legal guardian ID cards.
Please upload child's birth certificate.
Please sign the following form from the Department of Children & Families.
Financial Agreement & Information
The summer camp activity fee is due in addition to monthly tuition and is non-refundable and non-transferable.
PLEASE READ CAREFULLY:
● Daily late pick up fee of $1.00 for every minute for the first 10 minutes and $2.00 for every minute after 10 minutes after agreed time will be charged per child.
● Tuition will be charged on the first business day each month. Parents are required to enroll in the Tuition Express/ACH program (automatic debit from your bank account) for tuition payments. If for any reason, tuition is not paid, a late fee charge of $20 will be applied for EACH student. Children will not be allowed to attend school if tuition is overdue for more than 5 business days, until tuition and all late fees are paid in full.
● Summer Camp Sessions are scheduled as a complete block and cannot be broken up into separate dates.
● For any ACH/ payment returns, there will be a $30 service fee (in addition to $20 late fee) for EACH student and all ACH returns. Non-payment of tuition may result in immediate dismissal from the program. After multiple ACH returns, money orders may be the only form of payment accepted.
● Withdrawals must be communicated to the school in writing a full calendar month IN WRITING (i.e., notify on the 1st of the preceding month). Tuition will be charged until the child is formally withdrawn. If a child is withdrawn or terminated from the school for any reason and after tuition has been paid in advance, refunds will not be provided. Failure to provide proper notification of withdrawal will result in parents being obligated to pay a full month’s tuition. If tuition and fees are not paid, the account will be sent to a collection agency.
● All fees and payments are nonrefundable and non‐transferable towards another student or towards any other fees. Reductions will not be made for vacation, holidays, illness, quarantine, or weather‐related closures.
Parent #1/ Legal Guardian Signature
Parent #2/ Legal Guardian Signature
ACH FORM
This authority is to remain in full force and effect until School has received written notification from me (or either of us) as indicated above.
Signature