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| HOUSE RULES
As adults, we try to respect the wishes of others around us as best we can. It is up to us and those who care for our children to teach them to respect others as well, and to teach them acceptable behavior. One way to be sure that everyone is aware of what is acceptable in the Home Day Care is to have House Rules. These rules are reminded and enforced to ensure the safety of everyone in the home. They are for keeping our home clean and in good repair not only for us but for your children to play in. We want to be sure that everyone in and around our home is happy. 1) NO biting, hitting, pushing, shoving or any undesirable physical contact. Please respect the space of others. 2) Name calling intentionally to hurt another's feelings is not allowed. Please treat others as you would like them to treat you. 3) In the House: NO running or rough housing in the home. This can be done during time spent outside. Also there are some areas that are off limits. You are only allowed in those areas with my permission. 4) Children 7 years old and up are not allowed to leave the house or yard without MY permission and without written permission from their parent. Children 5 years old and up will be allowed to spend time outside in the day care yard with periodic supervision with MY permission and with written permission from their parent. 5) NO shoes allowed past the entrance room. NO EXCEPTIONS. This allows for a safer, cleaner play area for all of us. If your child wishes, he/she can bring a pair of slippers to wear inside. 6) NO picking up other children, especially infants and toddlers. 7) We have a share policy on all toys, including toys brought from home. If your child does not wish to share his/her toys, we will allow them to be shown during share time and then they will be put away for the rest of the day. Your child will be allowed to play with them if all other children have left for the day and they are the last one to be picked up. Also, I will not be responsible for damaged or lost toys brought from home. 8) Proper use of day care toys and equipment is required at all times for safety reasons and maintenance. Age appropriate toys and equipment are available for all ages. Be sure that what you are using is just right for you. 9) Nap/quiet time is required every day to meet the needs of all the children in my care. If you no longer take a nap, you will still be required to take a quiet time so that the other children that do nap can do so without disruption. Children 5 years and up will be allowed outside time with periodic supervision and with the understanding that they can not come in and out of the house causing disruption of nap/quiet time. THANK YOU FOR YOUR COOPERATION! |
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| House Rules |
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| Permission Form |
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| CARE
Kelly Sievert and/or Dawn Burke has my permission to seek and obtain emergency medical /dental or surgical treatment as prescribed by a treating physician for my minor child. I give my permission for my child to be transported by car or ambulance to an emergency center for treatment. Full Name of Minor: _______________________________ Birth Date: _________________________ Allergies to Med.: ______________________ Special Health Problems: _________________ Regular Medication: _____________________ Blood Type ______/ _____ Date of last physical exam:_________________ Name of regular Doctor ___________________________ Name of Insurance Co.: _____________________________ Member/Policy Number: ________________ Name of Policy Holder:________________ Employer: ___________________ I shall not be responsible for providing or paying for the child's health care. I agree that neither I or my child will bring any claims of any kind against Kelly's Kiddy Kare as a result of any injuries, expenses or damages that I or my child may suffer in any way related to the use of our facilities, toys, other children, whether such claims are known or unknown or arise in the future. Parent/Guardian Signature: _______________________________________ Date:_______________ *** MEDICINE Kelly Sievert and /or Dawn Burke has my permission to administer over the counter type medication ( Tylenol, Dimetapp, Diaper rash ointment, and Sun block ect. ) to my minor child/children. ________________________ / ____________________________ Parent/Guardian Signature:_________________________________ Date:____________________ Kelly Sievert and/or Dawn Burke has my permission to administer prescription medication to my minor child/children: __________________/_____________________ this being in the original container with the child's name, date prescribed, and dosage on the label. Parent/Guardian Signature:________________________________ Date:_____________________ *** TRIPS Kelly Sievert and/or Dawn Burke has my permission to transport my minor child/children: _________________/_________________ in her private vehicle. Trips will not be out of the Philadelphia area without further permission, and each child will be in the appropriate car restraint. Parent/Guardian Signature:_________________________________ Date:_____________________ *** GENERAL Kelly Sievert and/or Dawn Burke has my permission to: Take my child/children on a walk Yes No Take my child /children swimming Yes No Take photos of my child/children Yes No Give an occasional candy treat Yes No Assist my child/children with any toilet training procedures Yes No Parent/Guardian Signature:_______________________________ Date:________________ REGISTRATION FORM Child's Full Name___________________Birth date __________________ Nickname __________________________ Home Address___________________________ Home Phone_________________ Mother's Name___________________________ Occupation __________________ Place of employment ______________________________ Work Phone _________________ Cell phone or Beeper _____________ Father's Name ____________________________ Occupation _________________ Place of employment _______________________________Work Phone_________________ Cell phone or Beeper _____________ Parent/Guardian with legal custody: _____________________ Parents are: Married /Divorced /Separated / Single If parents are separated or divorced, please indicate whether the other parent has permission to have contact with the child at Daycare, and whether or not he/she is allowed to pick up the child. If there is a no contact order for the noncustodial parent, I will need to have a copy of the paper work. Contact: YES NO Pick Up: YES NO NOT APPLICABLE *** Emergency Contact Person in addition to parents. They must be within a 20-mile radius. Name/relationship__________________________Phone___________________ Name/relationship_________________________Phone__________________ *** Other than you, who has permission to pick up your child? Any persons not listed will not be allowed access to your child. Anyone other than the parents will be required to show photo identification at pick up. Anyone (including parents) should have proper child restraints for transportation. Name____________________________________Phone_________________ Name____________________________________Phone_________________ *** Has your child been in day care before? If yes please answer the following. YES ( ) NO ( ) Child's last Daycare Provider information: Name __________________________ Phone ___________________ Dates attended: from _______________ to _________________ Why was care terminated? _________________________________________________________________ May I contact them for a reference? YES ( ) NO ( ) Parent/Guardian Signature ______________ Date ________________ Date child entered care ______________Date child left care ______________________ CHILD'S PROFILE Child's Name________________________________________ Age_____________ Has or does your child have any known health problems? YES ( ) NO ( ) If YES describe:____________________________ Does your child need regular medication for the health problem YES ( ) NO ( ) If YES, what and when is it given? _______________________ Please sign the permission forms, authorizing Kelly's Kiddy Kare to administer the medication if needed. Any allergies? YES ( ) NO ( ) If YES, list Allergens: Special instructions in the event of an allergic reaction: List communicable diseases your child has had:(Circle those that apply) Chicken pox German measles Measles Mumps Other Is your child prone to:(Circle those that apply) Stomach upsets Colds Headaches Sore throats Ear aches Are there any indications of vision or hearing problems? YES ( ) NO ( ) Has he/she had any recent serious illness? YES ( ) NO ( ) Does your child have any mental or physical disabilities? YES ( ) NO ( ) If YES please explain: _____________________ Do you have a back up plan if your child is ill and cannot attend? YES ( ) NO ( ) What is your child's eating habits? (Times child usually eats, mind trying new things) __________________________________________________________________________________________ If your child is drinking formula do they prefer it cold or warm?______________ Child's usual dining habits: (Circle those applicable) HIGHCHAIR TABLE USES UTENSILS BOTTLE SIPPERCUP REGULAR CUPS Does your child have a small or large appetite?_______________________________________________ Favorite Foods:_________________________________________________________________________ Strong Dislikes:_________________________________________________________________________ How would you describe your child's personality? _______________________________________________ Does your child have a regular bedtime schedule? YES ( ) NO ( ) Does your child have sleep apnea?__________ Night terrors?____________ Walk in sleep?_______________ If infant- how do you prefer your child placed in the crib (front, back, side) ______________ What time do they usually go to bed/afternoon nap? ______________/_____________ What time do they wake in the morning? ________________________ What is their disposition when waking up? i.e. happy, grouchy, clingy, slow________________________ Please list favorite activities:__________________________________________________________________ Please list favorite toys:_____________________________________________________________________ Is your child potty trained YES ( ) NO ( ) Do you wish me to help them with potty training while here? YES ( ) NO ( ) If so, how would you like their training to be approached?_____________________________________ Special instructions concerning care, medications or diet not mentioned above. Parent/Guardian Signature_______________________ Date________________ |
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