Edu-Care Registration

Edu-Care
LaSalle Peru Area Career Center
200 Ninth Street
Peru, Il, 61354
815-223-2454 ext:11
http://www.lpacc.org

Save & Return

Save your progress and complete this form later. (optional)

Child Enrollment Information/Forms

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Household / Adult Primary Contact

Relationship to Participant: *
 

Household / Adult Secondary Contact

Relationship to Participant:
 

Sibling Information

We use this information to establish relationships with the child and for situations where more than one child from the same household is enrolled.

Emergency Medical Care Consent Form

This authorizes the Instructor of Edu-Care to secure EMERGENCY medical care for my child when I/We cannot be immediately reached at the time of emergency.  I/WE will be responsible for the emergency medical charges upon receipt of the statement.
Signature of Parent/Guardian Filing this Form (use stylus or finger on touch screen, or mouse/touch pad on traditional computer. A signature must be present for enrollment. *
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Emergency Care Information

May we call another physician if the above is not available? *
I authorize the following people to be contacted in case of illness, accident, or other emergency. I also give authorization to any of these people to pick up my child if I am unable to be reached. (You may enter up to three people. For each person enter their name, phone number, and relationship to the child. If you are entering multiple people simply press the + sign after each one is entered and an additional line will be opened to enter information for the next person). *
Does your child have any evidence of hearing loss or hearing difficulties? *
Please enter any allergies the child may have (You may enter up to 10). For multiple allergies simply press the + sign after each one is entered and an additional line will be opened to enter information for the next person). *
Please enter any medications the child may take (You may enter up to 10). For multiple medications simply press the + sign after each one is entered and an additional line will be opened to enter information for the next person).
Signature of Parent/Guardian Filing this Form (use stylus or finger on touch screen, or mouse/touch pad on traditional computer. A signature must be present for enrollment. *
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Photography/VideoTaping

I/We authorize Edu-Care to photograph/vidotape my/our child for the following purposes only; promotional material for pamphlets, newspaper article, newsletter information, teaching material(for students and educators) to advance the child-care profession. I/We understand that any/all photos, negatives, and videotapes will remain in the possession of Edu-Care and are not released to other entities or organizations.  I understand that if my/our permission is not given my/our child will not be denied enrollment.
Consent *
Signature of Parent/Guardian Filing this Form (use stylus or finger on touch screen, or mouse/touch pad on traditional computer. A signature must be present for enrollment. *
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Enrollment Questionnaire

The follwing requested information is for the Instructor and students to use in interacting with your child.  To help the child feel respected and comfortable, the information will be used to guide interactions, develop appropriate lesson plans, and gauge appropriate course of action to promote growth and development.

Is Your Child?

Check all that apply: *

Interests and Experiences

Daily Arrival and Departure of Children

Parents and guardians make arrangements for their child(ren) to be dropped off and picked up at the agreed upon time (this is done at enrollment).  If there is a change in schedule, the parent or guardian will speak with the Edu-Care Center Instructor or designee to make arrangements for the child(ren) to be dropped off and picked up at the new agreed time (if agreed to, this will be written into the child's file).
 
If ther eis an emergency, there will be an excused pickup of once per year.
 
An unexcused pickup will result in the emergency number being called and a late fee of $5.00 charged (starting at 1:00 minute past 11:00 a.m. which is our closing time for the morning).  In the afternoon  session late pickup will start at 1:00 past 2:30.  For each additional 10:00 minutes, there will be an additional $5.00 late fee assessed.  At the time of pickup, you will receive a notoce to meet with the instructor or designee.  The late fee will be due at the time of pickup.
 
Pickup for the morning session of Edu-Care will be 11:00 a.m. on Tuesday-Wednesday-Thursday during Edu-Care operational hours.  Pickup for the afternoon session of Edu-Care shall be 2:30 p.m. on Tuesday-Wednesday-Thursday during Edu-Care operational hours.
I have read the guidelines listed above (for child pickup) and via my signature affirm that I agre to and will abide by their stipulations. Signature of Parent/Guardian Filing this Form (use stylus or finger on touch screen, or mouse/touch pad on traditional computer. A signature must be present for enrollment. *
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Parent and Area Career Center Policy Agreement

1.  I/We agree to keep emergency information up to date and current.
2.  I/We agree to notify the Area Career Center instructor of any changes in enrollment information such as phone numbers or address.
3. I/We agree not to send any child to the Child Care Class if he/she has a temperature or appears sick.  I/We understand that the Area Career Center may require me/us to bring my/our child home if he/she is ill.
4. I/We agree that the Child Care Class will occasionally serve a snack to the my/our child (in accordance with any dietary restrictions the child may have).
5. I/We agree that my/our child must be up to date on immunization shots.
6. I/We agree not to allow my child to bring any food, money, or toys unless the instructor requests them to do so.
7. I/we agree to allow the my/our child to be observed in a group for diagnostic purposes.  This informatioon will remain confidential.
8. I/We agree with the guidance discipline managment policy.
 
I/We understand and agree to abide by the above policies of the Area Career Center.
 
 
Signature of Parent/Guardian. Signature of Parent/Guardian Filing this Form (use stylus or finger on touch screen, or mouse/touch pad on traditional computer. A signature must be present for enrollment. *
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