Please Complete and Submit This Form for Child Enrollment in the CDC!
CHILD CARE INFORMATION:
Do you have a back-up Child Care provider?*YesNo
By CHECKING the box above, I/We hereby give Higher Ground Child Development Center permission to take my/our child, off the premises and on excursions that will take place during regular childcare hours. I understand that I will be notified of any such trips beforehand, that trips will be supervised and that all precautions will be made for the safety and well being of all the children. I/We also understand that Higher Ground Child Development Center will not be iable for any accident or injury.
Consent is for normal activities unless indicated below – The following activities may occur during the course of the day at Higher Ground Child Development Center.
Please initial those activities your child does not have permission to participate in:
Child should not go for walks.
Child should not ride a bike.
Child should not be able to play in water.
Child should not ride in wagon/stroller.
Child should not go on field trips.
The following persons have my permission to pick up my child from the Center:
Existing Students - $35, New Students $55*New Student Fee - $55Existing Student Fee - $35
Please CHECK the CHECKBOX if you give permission for your child‘s photograph on the website, fliers, brochures or any other publication relative to Higher Ground Child Development Center. We realize that our child’s first or last name will not be used in such publications.
No child may be released from Higher Ground Child Development Center to any person other than his/her parents or other person designated in writing by such parent to receive the child. Those people designated to pick-up the child (including parents) need to present photo identification each day until easily recognized by the provider
The following persons have my permission to pick-up my child from the Center:
I/We certify that all of the information given on this form is correct and accurate according to our best knowledge. I/We promise that I/We will notify the provider, if any or all of the information changes.
2 + 2 = ? Please prove that you are human by solving the equation *
I would like to make a donation in the amount of:
I would like this donation to automatically repeat each month