Pride Academy West Pride Academy West 2 Pride Academy North 5615 W. 22nd Street 5570 Crawfordsville Rd 6080 N. Michigan Rd Indianapolis, IN 46224 Speedway, IN 46224 Indianapolis, IN 46228 317-241-1553 317-251-1553 317-251-1553 317-247-5788 Fax

Welcome to Pride Academy

As founder and Executive Director of Pride Academy Childcare, my entire staff and I would like to congratulate you on an awesome decision to place your child in the care of our family.

Pride Academy takes a ‘Faith Based’ approach to nurturing your child’s development. It is our goal that each child, preschool-age and under be prepared for kindergarten when his/her time comes to begin school. Children that have already begun their educational journey are encouraged to be open to learning and the guidance of those who are there to help them along the way.

Pride Academy is committed not only to your child, but to the entire family as a whole.

At Pride Academy the atmosphere is always filled with love and the promise of a brighter tomorrow. We are excited to have your

family aboard!

If ever you have an issue or concern, my staff and I are readily available. My door is always open.

Again, congratulations and welcome to our Pride!

Ms. Alisia Apple Executive Director

Pride Academy West Pride Academy West2 Pride Academy North 5616 W.22nd St 5570 Crawfordsville Road 6080 N. Michigan Road www.prideacademy317.com Indianapolis, IN 46224 Speedway, IN 46224 Indianapolis, IN 46228 Email-prideacademyinc@yahoo.com 317-247-1553 317-241-0288 317-251-1553 Executive Director, Mrs. Alisia Apple

REGISTRATION APPLICATION CHILD INFORMATION

Last Name: First Name:

Date of birth: Male Female

Allergies/Special Needs:

Last Name: First Name:

Date of birth: Male Female

Allergies/Special Needs:

Last Name: First Name:

Date of birth: Male Female

Allergies/ Special Needs:

Last Name: First Name:

Date of birth: Male Female

Allergies/Special Needs:

PRIMARY SPONSOR INFORMATION

Name: Relationship:

Address:

City: State: Zip Code:

Phone: Alternate Phone: Email:

PRIMARY SPONSOR EMPLOYMENT INFORMATION

Employer:

Employer address:

City: State: Zip Code:

Phone: Phone:

SECONDARY SPONSOR INFORMATION

Name: Relationship:

Address:

City: State: Zip Code

Phone:

SECONDARY SPONSOR EMPLOYMENT INFORMATION

Employer:

Employer address:

City: State: Zip Code:

Phone:

EMERGENCY CONTACTS

Name: Phone: Home Cellular Work

Name: Phone: Home Cellular Work

Name: Phone: Home Cellular Work

Pride Academy West Pride Academy West2 Pride Academy North 5616 W.22nd St 5570 Crawfordsville Road 6080 N. Michigan Road www.prideacademy317.com Indianapolis, IN 46224 Speedway, IN 46224 Indianapolis, IN 46228 Email-prideacademyinc@yahoo.com 317-247-1553 317-241-0288 317-251-1553 Executive Director, Mrs. Alisia Apple

REGISTRATION APPLICATION PICK-UP PRIVILEGES

***Identification (State ID/Driver’s License, Passport) is required in order for an individual to pick up your child.

Name: Phone: Alternate Phone:

Name: Phone: Alternate Phone:

Name: Phone: Alternate Phone:

PHYSICIAN INFORMATION

Physician Name: Phone:

Address

I, _______________________________________, the parent/legal guardian of the above listed child(ren) hereby authorize emergency medical treatment for my child in the event I cannot be responsible for the cost of such treatment. I,________________________________________, the parent/legal guardian of the above listed child(ren) hereby give permission for my child(ren) to take field trips with his/her caregiver.

Name of Parent/Guardian: ___________________________________________________________________ Signature of Parent/Guardian: _______________________________________ Date:__________________

The following MUST be complete prior to the child’s start date: Complete Registration Packet Well Child Check-up physical signed and dated by physician (Within 1 year) Immunization Records (must be current) An extra change of clothing Unopened items (if needed):Diapers, wipes, baby food, formula and 3 bottles First week’s payment (cash paying or CCDF co-payments)

All ABOUT ME!

Infants Information sheet

Infant room 1 year old room First Name _______________________________________________ Last Name ______________________________________________

Address___________________________________________________ City_____________________ State______________ Zip _________

Phone Number __________________________________________ Birthdate ____________________________ Age _____________

My current medical conditions are: ________________________________________________________________________________________________________________ ________________________________________________________

My current food allergies: ________________________________________________________________________________________________________________________________________________________________________

My Sleep Times

Wake Up Daily Nap Bedtime

To help me relax and go to sleep, I enjoy ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________

My Meal Times

Breakfast Snack Lunch Snack Dinner

Circle one: I am breast fed I am bottle fed I drink from a Sippy cup

Type of formula: ________________________________________________________________________________________________________ Special instructions for preparing my formula: ______________________________________________________________________ I enjoy eating_____________________________________________________________________________________________________________

The following items must be provided on the child’s first day of attendance: food, formula, water, diapers and

wipes must be in original unopened store bought packaging.

Please provide an extra weather appropriate change of clothing.

Thank you.

Preschool Age Information Sheet

Age Group 2 3 4 5

Child’s Name _______________________________________________________ Nick Name ____________________________________

Address_______________________________________________ City______________________________ State________ Zip ________

Phone Number ______________________________________________ Birth date _______________________ Age _______________

Parents/Guardian Name________________________________________________________________________________________________

Siblings Name and Age _________________________________________________________________________________________________

Pets Type and Name_____________________________________________________________________________________________________

Left Handed Right Handed

Does your child use the following at home? (Please circle all that apply)

Crayons Pen/pencil Markers Scissors Puzzles Balls/blocks Paint

Books Computer IPod I Pad Spoon/fork/Knife Ride Tricycle/bike

Favorite Toys, Books, Songs, or Games: ____________________________________________________________________________________________________________________________ Please tell us about the things your child enjoys doing: ____________________________________________________________________________________________________________________________ Does your child play well with the other children? Yes No

Does your child have opportunities to play with other children? Yes No

My child is (check one)

______in diapers ______toilet trained ______in the process of being trained ______needs bathroom assistance

Can your child identify: (Please circle all that apply)

Body parts Colors Shapes Numbers Letters

What would you like to see your child learn/do during this school year? _________________________________________ ____________________________________________________________________________________________________________________________ Additional information that will help us to know your child better:________________________________________________ ____________________________________________________________________________________________________________________________

School Age Children Personal Information Sheet

Age Group ___6 ___7 ___8 ___9 ___10 ___11

Child’s Name ____________________________________________________________ Nick Name ______________________________

School____________________________________________________________________ Grade____________________________________

Address_______________________________________________________________ City ______________State___________ Zip _________

Phone Number _________________________________________________ Birth date ______________________ Age _____________

Parents/Guardian Name________________________________________________________________________________________________

Parents/Guardian Name________________________________________________________________________________________________

Siblings Name_________________________________________________________________ Age_______________ Siblings Name_________________________________________________________________ Age_______________ Siblings Name_________________________________________________________________ Age_______________ Siblings Name_________________________________________________________________ Age_______________

Pets Type and Name_____________________________________________________________________________________________________

What are your favorite school subjects? _____________________________________________________________________________

What are your hobbies? ________________________________________________________________________________________________

Name three things that interest you most?

1.__________________________________________________________________________________________________________________

2._________________________________________________________________________________________________________________

3._________________________________________________________________________________________________________________

Would you be interested in learning and participating in any of the listed activities? (Circle all that apply)

______Summer Camp _______Chess Club

______Winter Camp _______Music

______Transportation _______Karate

______Boy Scouts _______Girl Scouts

______Orchestra _______Aerobics

______Pride Academy Kids Mentoring

CHILD HEALTH INFORMATION RECORD

Last Name _________________________________________ First Name____________________________________________________ Birthdate __________________________________________ Sex: Male Female

Address _______________________________________________________________________________________________________________ City_________________________________________________ State___________________________ Zip ___________________

Telephone _________________________________________ Cellular Home Office

Email: ________________________________________________________________________________________________________________

Physician’s name _____________________________________________ Physician’s Phone # ___________________________

Medical History: (Examples: Allergies, Diabetes, Asthma, ADHD, Bee Stings, Seizures, etc.) __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________ Current Medications: (List all medications dosages and times) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Emergency Contacts:

Parent’s Name ______________________________________________ Telephone______________________ (Home, Cellular, Work)

Parent’s Name ______________________________________________ Telephone______________________ (Home, Cellular, Work)

Other Emergency Contacts: (Please list first number to call)

___________________________________________________________ _____________ ___________________________________________________________ _______________________________________

Name Phone (Home, Cellular, Work) Relationship to Child

_________________________________________________________________________ ___________________________________________________________ _______________________________________

Name Phone (Home, Cellular, Work) Relationship to Child

________________________________________________________________________ ___________________________________________________________ _________________________________________

Name Phone (Home, Cellular, Work) Relationship to Child

West: 5615 W 22nd Street, Indianapolis, IN 46224 317.247.1553 West 2: 5570 Crawfordsville Road, Speedway, IN 46224317.241.0288 North: 6080 N Michigan Road, Indianapolis, IN 46228 317.251.1553 Mrs. Alisia Apple, Executive Director 317-373-5183

CONSENT FOR MEDICAL TREATMENT OF A MINOR CHILD

Childs Name___________________________________________________________ Birth date_______/_______/_______

Childs Name___________________________________________________________ Birth date_______/_______/_______

Childs Name___________________________________________________________ Birth date_______/_______/_______

Childs Name___________________________________________________________ Birth date_______/_______/_______

Childs Name___________________________________________________________ Birth date_______/_______/_______

I, _______________________________________________________________________ Birth date ______/_______/_______

the parent/guardian of the above listed child(ren) hereby authorize adult employees (over age 18) of

Pride Academy to provide transportation and consent to necessary medical treatment for my minor

child(ren). The consent is not limited, but may include authorization for certified medical personal to

perform examinations, health treatment, and physical diagnosis, administer anesthetic, execute surgery,

or any medical treatment and/or hospital care to be rendered to the above minor children. Medical

consent must be given under the general supervision and/or advice of any physician or surgeon licensed

to practice medicine in the state of Indiana in the case that I cannot be contacted. This authorization of

consent is valid for limited ten (10) year period.

From Date ______________________________________________ to Date _________________________________________________ Signature: _________________________________________________________ Date: ________________________________________

Signature: _________________________________________________________ Date: ________________________________________

DISCIPLINARY MODEL NOTIFICATION

Pride Academy has implemented a disciplinary model which consists of the following:

“Peace Table” – The “peace table” instills conflict resolution with our children. If a child is in a disagreement with another student, the children will go to the “peace table” and learn to resolve the issue. If the issue is not resolved within 2-3 minutes the teacher will help the children to understand the importance of sportsmanship, personal space and respecting their classmates.

“Stop Sign” Reward System – The “stop sign” will consist of green, red, and yellow lights. Each child will be given a color for the day (green, yellow, or red). At the end of each week, every student that has all green buttons on the rewards calendar will receive a prize out of the treasure box. Green = Great day Yellow = Caution. Spoke to about behavior on at least 3 separate occasions. Red = Disruptive and interrupted class more than 3 times on one day.

“Parent Contact” – each week we strive to provide an array of opportunities for our children. If a

teacher speaks has to speak to a child more than 3 times in one day, a parent will be contacted. If the problem persists for two consecutive days, the child will be suspended for one day from Pride Academy.

We are striving to be #1 in loving, nurturing, empowering and teaching our children. Please help us to provide an affectionate and warm-loving environment, by encouraging the children to be peaceable with their peers. We aim to be a wonderful blessing to the children of Pride Academy.

Parent/Guardian Name ______________________________________________________________________ Parent Signature ______________________________________ Date_______________________________

Parent/Guardian Name ______________________________________________________________________ Parent Signature ______________________________________ Date_______________________________

West: 5615 W 22nd Street, Indianapolis, IN 46224 317.247.1553 West #2:5570 Crawfordsville Road, Speedway, IN 46224317.241.0288

North: 6080 N Michigan Road, Indianapolis, IN 46228 317.251.1553

EMERGENCY INFORMATION & AUTHORIZATION FOR RELEASE ADDENDUM Parent Name ________________________________________________________________ Birth date________/________/__________ Address ________________________________________ City_________________________ State______________ Zip Code__________ Phone Number ______________________________________________________________ (Cell Home Work Other) Child’s Name ________________________________________________________________ Birth date ________/_________/________

Child’s Name ________________________________________________________________ Birth date ________/_________/________

Child’s Name ________________________________________________________________ Birth date ________/_________/________

Child’s Name ________________________________________________________________ Birth date ________/_________/________

Child’s Name ________________________________________________________________ Birth date ________/_________/________

In the event of an emergency I am unable to be reached, the following individuals are authorized to drop-off and pick-up my child(ren). I understand photo identification is required to release my child(ren). Name _______________________________________________________________ Phone Number______________________________ Address: ________________________________________________ City_________________________ State_________ Zip____________ Name _______________________________________________________________ Phone Number______________________________ Address: ________________________________________________ City_________________________ State_________ Zip____________ Name _______________________________________________________________ Phone Number______________________________ Address: ________________________________________________ City_________________________ State_________ Zip____________ Name _______________________________________________________________ Phone Number______________________________ Address: ________________________________________________ City_________________________ State_________ Zip____________

Name _______________________________________________________________ Phone Number______________________________ Address: ________________________________________________ City_________________________ State_________ Zip____________

________________________________________________________________ ________________________________________ Parent/Guardian Signature Date ________________________________________________________________ ________________________________________ Parent/Guardian Signature Date

West: 5615 W 22nd Street, Indianapolis, IN 46224 317.247.1553 West 2: 5570 Crawfordsville Road, Speedway, IN 46224317.241.0288 North: 6080 N Michigan Road, Indianapolis, IN 46228 317.251.1553 Executive Director, Ms. Alisia Jackson-Apple 317.373.5183

EARLY EMERGENCY DISMISSAL In the event of an early emergency dismissal, we would like to make certain a child will be sent to a location where there will be adult supervision. Therefore, we are asking you to specify where your child will go if students are unexpectedly sent home early. In case of an emergency early dismissal, I want my child to: (Check only one)

� Ride Pride Academy Transportation � Personal vehicle of responsible party

This form will remain in your child’s file folder. If these plans should change, it is your responsibility to immediately inform Pride Academy. Childs Name__________________________________________________________ Birth date_______/_______/________

Childs Name__________________________________________________________ Birth date_______/_______/________

Childs Name__________________________________________________________ Birth date_______/_______/________

Childs Name__________________________________________________________ Birth date_______/_______/________

Childs Name__________________________________________________________ Birth date_______/_______/________

Parent/Guardian Name _______________________________________________________________________ Parent Signature _______________________________________ Date________________________________

*Should Pride Academy experience an evacuation at any of the above listed facilities, we will immediately transport children, in company insured vehicles, to another Pride Academy location listed above. It is crucial that the parent keep all contact information up to date and current.

Emergency Preparedness Plan Notification

Childs Name__________________________________________________ Birth date________/________/_________

Childs Name__________________________________________________ Birth date________/________/_________

Childs Name__________________________________________________ Birth date________/________/_________

Childs Name__________________________________________________ Birth date________/________/_________

Childs Name__________________________________________________ Birth date________/________/_________

I, ________________________________________ the parent/guardian of the above listed child(ren) hereby

acknowledge, I have received a copy of the Pride Academy’s Emergency Preparedness Plan in my Parent

Handbook. By signing below I am stating that I fully understand this plan and the course of action that will be

taken by Pride Academy in the event of an emergency. A written emergency plan is established and

implemented. The plan is shared with the parents at the time of enrollment and/or any time the provider initiates

a change in any aspect of the plan. The purpose of the written emergency plan is that all emergency policies and

procedures are clear to the parents.

The plan is to be signed by the parents to indicate their understanding and acceptance of the policies and

procedures. The written Pride plan will notify parents immediately in the event that a staff member becomes

contagious from illness, or any other emergency that will prevent children from being cared for in this facility.

There will also be a backup plan for care that the facility will arrange in an event of an emergency. The

parent(s) will need to have a backup plan for care in place in the event of their child’s illness or the facilities

inability to care for the children. Exclusion policies pertaining to a child’s health, alternative contacts, and

medical care authorization are available in case the parents cannot be reached in an event of an emergency. A

list will also be provided by the parents of who is authorized to pick up the children. A plan for fire evacuation

or any type of evacuation will be posted on the parent board located in the office. A plan for safe shelter during

a tornado or any other threatening weather emergency will take place in the cafeteria located in Pride Academy.

Signature _________________________________________________ Date ________________________

Signature _________________________________________________ Date ________________________

Field Trip Permission Form

Pride Academy takes great pride in allowing our children the opportunity to experiment, explore and adventure new opportunities in life. Offering field trips is one of many ways we bring this opportunity to life.

The events will include such adventures as: Roller skating, Bowling, Park and Recreation visits and much more.

Exact notice (date, time & location) will be given prior to each outing.

By signing this permission slip, you are granting Pride Academy and our affiliates authorization to transport your child(ren) to and from the events.

Childs Name________________________________________________ Birthdate _____/_____/_____ Childs Name________________________________________________ Birthdate _____/_____/_____ Childs Name________________________________________________ Birthdate _____/_____/_____ Childs Name________________________________________________ Birthdate _____/_____/_____ Childs Name________________________________________________ Birthdate _____/_____/_____

Parent/Guardian Name _______________________________________________________________________ Parent Signature _______________________________________ Date _______________________________

**If you would like for your child to participate in these events, please complete, sign, and return the following statement of consent & release of liability. As parent/legal guardian you remain fully responsible for any legal responsibility which may result from any personal actions taken by the named student(s). I understand that these events will take place away from school grounds and my child(ren) will be under the supervision of Pride Academy staff. I further consent to the conditions stated above on participation in these events, including the method of transportation.

HEALTH CARE PROGRAM FOR CHILD CARE CENTERSCHILD CARE CENTER HEALTH RECORDState Form 49969 (R4 / 2-15)

Name of child (last, first)

Address (number and street, city, state, and ZIP code)

Child lives with (relationship)

Date of birth (month, day, year) Date of admission (month, day, year)

Name Telephone number

MEDICAL HISTORY

Allergies:

Handicapping conditions:

Other:

Communicable Disease Month / Year Condition Explain if present

PHYSICAL EXAMINATIONDate of exam (month, day, year) Age of child

SkinLymphnodesEyesEarsNasopharynxTeeth and Mouth

HeartLungsAbdomenGenitaliaSkeletonOther:

Note any unusual findings:

Does this child have any health condition that would be hazardous either to the child or to other children in a group setting as a result of participation in normal activities (including sports)?

If Yes, what modification of normal activities would be necessary to protect the child and the child's classmates:

Have you prescribed any medications or special routines which should be included in the center's plans for this child's activities? Explain:

Yes No

Yes No

(Over)

( )

FSSA - MS02402 WEST WASHINGTON STREET, RM W361

INDIANAPOLIS, IN 46204

Screenings Result / Date (month, day, year)TB Risk / SymptomDevelopmental ScreenLead

HISTORY OF IMMUNIZATIONS AND TEST (indicate month / day / year)

1 2 3 4 5

DTaP / DT

1 2 3 4 5

IPV (Polio)

1 2Measles MumpsRubella (MMR)

1 2 3 4

Hib

Name of physician / nurse practitioner completing form (please print) Telephone number

Signature of physician / nurse practitioner

ADDITIONAL NOTES AND INSTRUCTIONS

* Recommended yearly.

1 2 3HBV (HEP B)

1 2Pneumococcal(PCV) (Prevnar)

3 4

( )

1 2 3 4 5

Influenza (Flu)

1 2 3

Rotavirus (RGE)

1 2Varicella (Varivax) or Chicken Pox Disease

Month / year

1 2

HEP A

*

PARENT DIRECTIVE FOR INFANT SAFE SLEEP POSITION

Childs Name_________________________________________ Birthdate _____/______/_____ Infant 1 year old

Childs Name_________________________________________ Birthdate _____/______/_____ Infant 1 year old

Pride Academy recommends back sleeping for all babies. At Pride Academy we must place an infant in a crib to sleep directly on a firm mattress and must position the infant on his/her back to sleep unless there is a signed directive from a parent or legal guardian for an alternate sleep position. Car seats, swings, couches, rockers or on the floor are not acceptable as an alternative sleep position. Pride Academy uses a fitted crib sheet that fits tightly on the mattress and overlaps the mattress so it cannot by dislodged by pulling on the corner of the sheet. Pride Academy also only uses cribs that meet specific requirements specified in regulations and cribs are checked monthly to assure that they are safe. These requirements apply to all license holders that serve infants up to and including twelve months of age.

Babies sleep safest on their backs. One of the easiest ways to lower a baby’s risk of Sudden Infant Death Syndrome (SIDS) is to put him/her back to sleep for naps and at night. Since the recommendation to place a baby on his/her back for sleep began, the SIDS rate in the United States has dropped by more than fifty percent. Placing babies on their back to sleep is the number one way to reduce the risk of SIDS.

The following are recommendations for safe sleep for your baby: 1. Your baby should always be put on his/her back to sleep. The back sleep position is safest and every sleep

time counts. 2. Your baby should be put to sleep on a firm sleep surface, such as a safety-approved crib mattress covered

by a fitted sheet. Never place a baby to sleep on a pillow, quilt, fluffy blanket or other soft surfaces. 3. Keep soft objects, toys and loose bedding outside of the baby’s sleep area. Do not use pillows, blankets or

quilts. By signing this form I acknowledge that I am aware that placing a baby on their back has been recommended by health experts to be the safest way for babies to sleep. I am aware that placing a baby on their tummy or alternate position other than their back for sleep places the baby at a greater risk for Sudden Infant Death Syndrome (SIDS). Parent Signature __________________________________________________________ Date ___________________________

Directive for Alternate Sleep Position: By signing below I acknowledge that I have read the information regarding Safe Sleep and that I am directing my provider to always:

Place my baby on his/her stomach for sleep periods (not recommended) Place my baby in an alternate position for sleep periods (not recommended) List alternate position ________________________________________________.

Parent Signature __________________________________________________________ Date ___________________________

PARENT HANDBOOK By signing below you acknowledge youhave received a copy of Pride Academy’s Parent Handbook. Please familiarize yourself with its contents. (Revised January 2016) Parents Name ______________________________________________

Parent Signature _____________________________________________ Date____________________________

Child(ren) Name(s)

1.___________________________________________________________ Birthdate _______/________/_______

2.___________________________________________________________ Birthdate _______/________/_______

3.___________________________________________________________ Birthdate _______/________/_______

4.___________________________________________________________ Birthdate _______/________/_______

5.___________________________________________________________ Birthdate _______/________/_______

6.___________________________________________________________ Birthdate _______/________/_______

Pride West 5615 West 22nd Street Indianapolis, Indiana 46224 (317) 247-1553 Office (317) 247-5788 Fax

Pride West #2 5570 Crawfordsville Road Speedway, Indiana 46224 (317) 241-0288

Pride North 6080 North Michigan Road Indianapolis, Indiana 46228 (317) 251-1553

Executive Director Mrs. Alisia Apple (317) 373-5183

prideacademyinc@yahoo.com www.prideacademy317.com

Facebook/Instagram/Twitter prideacademy317

Parents please read and acknowledge by initialing each section. Thank you.

Court Orders Pride Academy shall comply with all court orders preventing a particular individual from having contact with a child. A copy of this order must remain in child’s file. Parent/Guardian Initials______ Immunization and Health Examinations A health examination (within 12months), including up-to-date immunization required for each child prior to attending Pride Academy. Child care services will be terminated if vaccinations are not kept current.

Parent/Guardian Initials______ Attendance When your child is not attending, for any reason (illness, personal, financial) please inform Pride Academy’s office staff immediately. If your child(ren) are absent for 10 consecutive days and you have failed to contact the office, your child(ren) will be withdrawn and his/her spot will be lost and given to another child.

Parent/Guardian Initials______ Withdrawal If you decide to withdraw your child(ren) for any reason, please complete a Withdrawal Form.

Parent/Guardian Initials______ Extracurricular Activities In the event of extracurricular activities (Field Trips, Boy & Girl scouts, etc.), you will be informed prior to the event. A signed-written permission form is required for your child to participate. (A nominal fee may apply)

Parent/Guardian Initials______ Reporting Suspected Child Abuse By law, Pride Academy’s staff is required to report any suspected child abuse and/or neglect to Child Protective Service. Parent/Guardian Initials______ Tobacco,Alcohol, Illegal Substance and Firearms Tobacco, alcohol, drugs, illegal substance and firearms are not permitted on premises. The use of tobacco, alcohol and illegal substance and the possession of firearmsare prohibited.

Parent/Guardian Initials______ Photo Release Pride Academy often photographs children, involved in child-care activities and events, to display within the facility, in our newsletters, electronic media and social websites. If the parent/guardian objects to their child(ren) being photographed please provide the office staff with a written notice.

Parent/Guardian Initials______

Authorization for Child’s Release Children will be releasedonly to a parent or a person listed as an authorized/emergency contact on the students enrollment form. Parent or people named by the parent must make sure the student is signed in and out each day.

Parent/Guardian Initials______

1. Registration: A one-time $35.00 registration fee is required to be paid by the first day your child/children attend. At certain times this fee may be waived.

The following documents must be received before care begins: a. Registration Packet fully completed and signed b. Physical/Well Child visit that has been done within the last year c. Updated and current shot records

** It is vital that these documents are kept current. If there are any changes (i.e. change of address, phone number, change in emergency contacts, etc.) the parents/guardians must notify Pride Academy immediately. Shot records must be resubmitted to Pride Academy each time your child/children receive a new immunization.

2. Childcare Fees &Payment Policy:

The fee for childcare at Pride Academy is as follows:

Child’s Age Fee 6 weeks – 1 year $192.60 weekly 1 year olds $155.10 weekly 2 year olds $149.80 weekly 3 year olds $144.45 weekly 4 year olds & 5 year olds NOT in kindergarten $133.75 weekly 5 year olds that attend kindergarten – 11 year olds $107.00 weekly

a. Payments are to be made on Friday for the following week, with no deduction for absences. You may

pay by cash, credit/debit card, money order, or check. b. Late Fee – any payment that is not received by Friday will incur a $20 late fee. Failure to pay by Monday

when you enter will result in your child not being able to attend until payment is received. c. CCDF – If you have a CCDF voucher you must swipe your child in everyday upon entering. Failure to

swipe your child in will result in your child not being able to stay. If someone else drops off your child they must have your CCDF card, or you must give them your card number and pin. We recommend that you write your CCDF card number down in a safe place, that way if your CCDF card is lost you can enter it manually. If your child is absent you must enter a personal day. If you are assigned copay by CCDF, it must be paid following the guidelines listed above.

d. Returned Checks – If a check is returned to the bank, the parent will be charged an additional service fee of $35.00. After two (2) returned checks, no personal checks will be accepted.

e. Overtime Charges – Overtime is offered only on a prearranged basis or in emergency situations at the current hourly rate.

f. Extra Activities – Any extra activities your child may participate in may result in an additional expense. You will be notified of these activities well in advance and all activities are optional. Parents/guardians must pay for these activities by the day of the activity in order for your child(ren) to participate.

g. Rate Increases – Rate increases will be made not more than once per calendar year. There will be an annual rate review to address cost of living and operating cost changes.

3. Hours: a. Pride Academy opens at 5:00am and closes at 1:00am. Your child must be picked up no later than

1:00am. These hours are subject to change at any time. If our hours change you will be notified well in advance so that you may plan accordingly.

b. Normal full-time care is no more than nine (9) hours per day. This should allow adequate travel time for parents to and from work/school. If you need additional hours of care you must speak with an office staff member.

4. Holidays a. Pride Academy is generally closed for major holidays, including: New Year’s Day, Memorial Day,

Independence Day, Labor Day, Thanksgiving and Christmas. b. Pride Academy may also be closed or may close early on minor holiday and days surrounding major

holidays. For example: the day after Thanksgiving, Christmas Eve, Christmas Day, etc. c. All holiday closings will be announced at the beginning of each year. Upcoming closings will also be

posted in the office and in our newsletters.

5. Arrival & Departure a. Only authorized adults may drop off or pick up your child. Your child will not be permitted to leave with

anyone other than the individuals listed on your registration packet. If you wish to add/remove individuals from your authorized pickup list, you must do so with an office staff member. Written or verbal requests will not be acknowledged at the time an unauthorized person arrives at Pride Academy, all changes in your pickup list must be done in advance and in-person. This is to ensure the safety of everyone in the center.

b. Your child must arrive at Pride Academy by 5:00pm in order to stay. No children will be allowed to enter after this time.

6. Health & Safety

a. If your child has any of the following symptoms they may not attend: fever, heavy nasal discharge, constant cough, vomiting, eye discharge or reddened eyes. In the event your child has one or more of these symptoms please do not bring them to Pride Academy until they are well.

b. Pride Academy will care for your child while ill only if the illness is minor, such as a cold. If you child becomes severely ill, begins to run a fever, or if in our judgment is too ill to remain at Pride Academy, you will be notified and asked to pick up your child. Please pick your child up promptly.

c. If your child is sent home due to being sick they must remain away from Pride Academy for 24 hours. With some conditions we may request that a doctor’s note stating that your child is not contagious be submitted before your child returns to our care.

d.

7. Meals: a. Pride Academy provides breakfast, AM snack, lunch, PM snack, and dinner to our children. Children are

provided, but not forced to eat, nutritious family-style meals. Pride Academy is a member of Child Care Providers, Inc. and participates in the State Child & Adult Care Food Program (CACFP) which helps ensure the quality of meals and snacks served.

b. For infants, parents must provide unopened formula and any baby food the parent wishes for their child to eat. Once your child transitions to milk, whole milk will be provided by Pride Academy during meal and snack times.

c. Outside food is not allowed at Pride Academy. Please do not bring in snacks for your child and do not bring your child to Pride Academy chewing gum, or eating candy or other food.

d. If your child has any food allergies or special dietary needs please indicate these on your registration packet and make sure to communicate them to office staff and your child’s teacher. We will make every attempt possible to accommodate any special dietary needs and/or restrictions.

SAFE TRANSPORTATION OF FOOD POLICY

Pride Academy receives food from an outside vendor in order to provide the best possible food for the children that attend our facility. In order to keep food safe and suitable for children to eat, the following transportation guidelines are in place and met at all times:

1. Food is brought to the facility in clean, insulated and sanitizable containers. 2. Food is kept cold during transportation at a temperature of 41 degrees Fahrenheit or lower. 3. Containers are clearly labeled with its contents and date of preparation. 4. Upon receiving the food, Pride Academy shall verify the temperature of the food. When potentially hazardous

food temperature is observed, Pride Academy will not accept the food. 5. Upon accepting the food, Pride Academy shall maintain correct food temperatures until served.

I have read and fully understand the Safe Transportation of Food Policy that has been established and is maintained by Pride Academy. I take full responsibility for any matters regarding the consumption of food while my child is at Pride Academy.

Childs Name_______________________________________ Birthdate__________/__________/___________

Childs Name_______________________________________ Birthdate__________/__________/___________

Childs Name_______________________________________ Birthdate__________/__________/___________

Childs Name_______________________________________ Birthdate__________/__________/___________

Childs Name_______________________________________ Birthdate__________/__________/___________

Parent/Guardian Name______________________________________________________________________________

Parent /Guardian Signature_____________________________________ Date____________________________

Parent/Guardian Name_______________________________________________________________________________

Parent /Guardian Signature_____________________________________ Date____________________________

5615 West 22Nd Street 5570 Crawfordsville Road 6080 North Michigan Road

Indianapolis, IN 46224 Speedway, IN 46224 Indianapolis, IN 46228 317-247-1553 317-241-0288 317-251-1553

TRANSPORTATION POLICY

Reason this policy is important: The safety of children and staff must be provided in all activities of child care programs. Proper restraint systems and the correct use of them are critically important during travel to/from the child care program as well as a part of the activities of the setting.

Procedure and Practices, including responsible person(s): • Consent for Child Care Program Activities form will be filled out for each child being transported. • Smoking is prohibited in vehicles used to transport children. • Children will be transported properly in a seat belt, car seat, or booster seat according to current Indiana regulations. Parents may be required to supply a booster or car seat as needed for their child if field trips involving use of transportation are a part of the program. Staff will be sure that car seats, booster seats and seat belts are used properly and each child is properly secured before setting the vehicle in motion. Staff will assist with releasing children from their transportation safety restraints, when needed. All adults in the vehicle will use proper restraining devices according to the vehicle manufacturer’s recommendations. • The number of passengers in the vehicle will not exceed the manufacturer’s stated capacity for the vehicle. • Children will be prohibited from eating, drinking, standing, or other dangerous or distractive activities during transportation. • Children will never be left unattended in a vehicle, even for brief periods. All children will be accompanied by an adult to/from the vehicle to assure safety. • All children will be accounted for before leaving the facility and again before returning. • Children with special needs will have their transportation plans addressed in the Special Care Plan. A staff member who is familiar with the child’s special needs will accompany the child during transportation. • All travel routes will be planned in advance.

Vehicle Requirements • Only insured, licensed, well-maintained vehicles will be used to transport children. 18 passenger vans are not permitted. • A back up vehicle will be available if needed and can be dispatched immediately in case of an emergency. • A first aid kit and list of emergency contacts for all children and adults will be in the vehicle during transportation of children. • A cell phone will be available in case of emergency.

Driver Qualifications • Drivers will be legally-licensed and shall not be under the influence of any chemical substance that may alter their ability to drive safely. • Drivers will meet staff qualifications including a criminal history check. • Drivers will be first aid and CPR certified if another staff member present is not. • Drivers will obey all traffic regulations. • The driver shall not be included in the child: staff ratio. Drivers must not be distracted from safe driving practices by being simultaneously responsible for the supervision of children. • The driver will be familiar with the planned route ahead of time. • Drivers will have evidence of a safe driving record for the previous 5 years. • To prevent distractions the driver is not permitted to talk on a cell phone or play loud music. (staff title/name) _____________________________________ is responsible for collecting background checks, driving histories and updating this information yearly for those who are transporting children. (staff title/name) _____________________________________ is responsible for ensuring the safety of the vehicle and proof of insurance for the vehicle.

When the policy applies: This policy is in force anytime children are transported by the child care program. Staff will adhere to the policy guidelines even if no children are present when using a vehicle owned by the child care facility.

Communication plan for staff and parents: Office/staff personnel will cover policies, plans, and procedures with all new staff (paid and volunteer) during orientation training. They will sign that they have read, understand and agree to abide by the content of the policies. • During enrollment this policy will be reviewed by Office/staff personnel with the parents. Parents will sign that they have read, understand, and agree to abide by the content of the policies. • A copy of all policies will be available during all hours of operation to staff and parents in the policy handbook. • Parents may receive a copy of the policy upon request. A summary of this policy will be included in the parent handbook. • Parents and staff will receive written notification of any updates. • Parents will sign consent for Child Care Program Activities form for all outings where transportation is required.

References: • Indiana Bureau of Motor Vehicles: www.in.gov/bmv or 317-233-6000 • National Highway Traffic Safety Administration: www.nhtsa.dot.gov or 888-327-4236 • Caring for Our Children – http://nrc.uchsc.edu • Model Child Care Health Policies – http://www.ecels-healthychildcarepa.org

Reviewed by: ___________________________________________________ Director/Owner

___________________________________________________ Health Professional (physician,nurse, health department, EMS, Health consultant)

____________________________________________________ Staff member

____________________________________________________ Parent, advisory committee, police, Child Protective Service)

Effective Date and Review Date: This policy is effective _______/_______/_______ and will be reviewed annually by ______/_______/_______ or sooner if needed. Parents and staff will be notified of any upcoming policy review. *This format is adapted from and used with permission of: National Training Institute for Child Care Health Consultants, UNC, 2000