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Resurrection Kids Registration
RLC Kids Registration Form
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Resurrection Kids Childcare Compliance Disclosure
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Resurrection Kids Registration Form
Resurrection Kids
A Ministry Outreach Program Supported by Resurrection Lutheran Church
675 W Vandament, Yukon, Ok 73099
(405) 354-3721 kim@rlcok.org
________ $100.00 Non-Refundable Registration Fee
________ Submit a current copy of Immunization record
Monday/Wednesday/Friday (Based on child's age as of Sept.1)
Kids Day Out –12-24 months (2 days required)
Preschool and Pre-K –3, 4 and 5 year olds (3 days required)
Circle hours desired:
Hours and Tuition:
8:30am-4:00pm Tuition: $27.00 per day
9:30am-3:00pm Tuition: $22.00 per day
Desired School Days:
Monday/Wednesday/Friday
(1 & 2 yr old classes only) ____Mon ____Wed ____Fri
Tuesday/Thursday: Kids Day Out:
(18-35 months) ____Tues ____Thurs
(3-5 years) ____Tues ____Thurs
Add-on Options:
Before Care $5.00 (8:00- 8:30am) ____Mon ____Tue ___Wed ____Thurs ____Fri
After Care $5.00 (4:00-5:00pm) ____Mon ____Tue ___Wed ____Thurs ____Fri
Student’s Name_________________________________________________________________
Age_________ Birthday__________________ Male____ Female____
Address: ___________________________________City___________________Zip___________
Best Contact Telephone Number___________________________________________________
Email Address___________________________________________________________________
Emergency Contact Number (other than parents) ______________________________________
Name__________________________________ Relationship_____________________________
Persons authorized to pick up your child _____________________________________________
______________________________________________________________________________
______________________________________________________________________________
The Remind App will be used for classroom and program communications via cell phone. You will receive a text prior to open house. Call if you have questions, 405-354-3721.
Father’s Name: ____________________________Occupation:___________________________
Cell #________________________
Mother’s Name: ___________________________Occupation:__________________________
Cell #_________________________
Siblings and their ages____________________________________________________________
______________________________________________________________________________
First time in a child care program? ____Yes ____No
Allergies/Reaction:______________________________________________________________
Serious Illness: __________________________________________________________________
Potty Trained (mark all that apply): _____Yes _____No _____Goes on their own _____Wipes
_____Washes hands _____Can pull up pants _____ button pants _____zip pants
Nap Habits: _____Rests easily _____With some assistance _____Does not nap
Attention Span Habits: (There are no incorrect answers, knowing your child helps us to place him/ her in the correct class.)
Likes to be read to: ____ Yes ____Sometimes ____Not really
Likes to Color: ____Yes ____Sometimes ____Not really
Stays focused on any given task: (Puzzles, blocks, play-doh) ____2 Min ____5 Min ____10 Min
Socialization Habits: (mark all that apply)
____Plays rough ____Generally shares ____Can take turns ____Likes to play with others
____Plays well alone ____Affectionate
General Health Agreement:
Please do not expect our program to take care of sick children. If your child has a fever,
(100 degrees or greater) vomiting, diarrhea, an ear ache, sore throat, skin eruptions (rash, boils, ringworm, impetigo etc.) constant cough, red or runny eyes, runny nose with colored mucus, an acute cold, a respiratory infection, or in general feels “icky”---PLEASE keep your child at HOME!
Children should be free of all the above described symptoms for at least 24 hours, without the use of fever/pain suppressants, before returning to school. If children become sick during the school day, we will notify you to come pick them up. We will make sure your child is as comfortable as possible as they await your arrival.
NIT FREE is our policy; therefore if we suspect head lice we will contact you immediately to come get your child. A child must be nit free for at least 48 hours before returning to school.
I have read the above and will honor the program’s health policies.
Doctor’s Name _____________________________________ Phone #______________________
Signature_______________________________________________Date___________________
Emergency Treatment Release
In the event of an illness or accident that requires immediate medical treatment at a time when a parent/guardian cannot be reached, I give permission for Resurrection Kids to provide such emergency treatment to the best of their knowledge and ability. I will not hold the program or medical personnel responsible. This is done with the understanding that every attempt will have been made to contact a parent/guardian and other persons listed as emergency contacts.
I authorize staff members who are trained in the basics of first aid and CPR to administer the needed care to the best of their abilities. In the event of an illness or accident that poses imminent danger (seizure, head injury etc.) Resurrection Kids staff will call 911, for professional treatment. Every attempt will be made to contact a parent/guardian or a designated emergency contact.
Signature_____________________________________________Date_________________
Publish Request
I here-by give Resurrection Lutheran Church/Kids the absolute right and permission to publish, copyright and use pictures of my child/myself for the purpose of promoting the ministry programs of Resurrection Lutheran Church/Kids. I understand that no names will be used to identify children without the expressed permission of parents.
Signature____________________________________________Date_____________________
Discipline Policies:
A positive, welcoming atmosphere is maintained in the program. All children are welcomed and secure. If there is a need to correct or redirect a child’s behavior, the methods used are not humiliating, frightening, or physically harmful to the child. Discipline is based on the child’s level of understanding and directed toward teaching the child acceptable behavior. If a “time- out” or “thinking time” is used, their age is taken into consideration; (i.e. 1 minute per year of age.)
If a child insists on behavior that is unacceptable, disturbing or harmful to others, parent(s) will be contacted, and possibly asked to take their child home for the remainder of the day.
Biting policy: Due to the seriousness of a bite injury, the program is required to enforce a strict policy to ensure the safety of students and staff. The following school procedures are for children who bite another student or a staff member.
First and Second incident: parents are notified and asked to pick up the child immediately.
Third incident: parents are notified and asked to pick up the child immediately and the child will be expelled from school for two weeks.
Fourth incident: Parents are notified and asked to pick up the child immediately and the child will be expelled from school for the remainder of the semester. Parents may pay 50% of tuition to hold the child’s classroom slot so that he/she will have the opportunity to return at semester change.
I have read the above and will honor the program’s discipline policies.
Signature____________________________________________Date______________________
Financial Policies
There is a non-refundable registration fee of $100.00 per student. This fee accompanies your enrollment form to reserve space in our program.
Tuition is $22/27 per day and is due the first week of every school month. A $10 late fee will be added to tuition if received after the due date; additional late fees of $10 per week will accrue if tuition is more than one week late.
Before care and after care fees are $5.00 per session.
Parents/Guardians are responsible for reimbursing the program a $30 NSF charge due to a returned check.
I have read the above and will honor the program’s financial policies
Signature_____________________________________________Date____________________
A Ministry Outreach Program Supported by Resurrection Lutheran Church
675 W Vandament, Yukon, Ok 73099
(405) 354-3721 kim@rlcok.org
________ $100.00 Non-Refundable Registration Fee
________ Submit a current copy of Immunization record
Monday/Wednesday/Friday (Based on child's age as of Sept.1)
Kids Day Out –12-24 months (2 days required)
Preschool and Pre-K –3, 4 and 5 year olds (3 days required)
Circle hours desired:
Hours and Tuition:
8:30am-4:00pm Tuition: $27.00 per day
9:30am-3:00pm Tuition: $22.00 per day
Desired School Days:
Monday/Wednesday/Friday
(1 & 2 yr old classes only) ____Mon ____Wed ____Fri
Tuesday/Thursday: Kids Day Out:
(18-35 months) ____Tues ____Thurs
(3-5 years) ____Tues ____Thurs
Add-on Options:
Before Care $5.00 (8:00- 8:30am) ____Mon ____Tue ___Wed ____Thurs ____Fri
After Care $5.00 (4:00-5:00pm) ____Mon ____Tue ___Wed ____Thurs ____Fri
Student’s Name_________________________________________________________________
Age_________ Birthday__________________ Male____ Female____
Address: ___________________________________City___________________Zip___________
Best Contact Telephone Number___________________________________________________
Email Address___________________________________________________________________
Emergency Contact Number (other than parents) ______________________________________
Name__________________________________ Relationship_____________________________
Persons authorized to pick up your child _____________________________________________
______________________________________________________________________________
______________________________________________________________________________
The Remind App will be used for classroom and program communications via cell phone. You will receive a text prior to open house. Call if you have questions, 405-354-3721.
Father’s Name: ____________________________Occupation:___________________________
Cell #________________________
Mother’s Name: ___________________________Occupation:__________________________
Cell #_________________________
Siblings and their ages____________________________________________________________
______________________________________________________________________________
First time in a child care program? ____Yes ____No
Allergies/Reaction:______________________________________________________________
Serious Illness: __________________________________________________________________
Potty Trained (mark all that apply): _____Yes _____No _____Goes on their own _____Wipes
_____Washes hands _____Can pull up pants _____ button pants _____zip pants
Nap Habits: _____Rests easily _____With some assistance _____Does not nap
Attention Span Habits: (There are no incorrect answers, knowing your child helps us to place him/ her in the correct class.)
Likes to be read to: ____ Yes ____Sometimes ____Not really
Likes to Color: ____Yes ____Sometimes ____Not really
Stays focused on any given task: (Puzzles, blocks, play-doh) ____2 Min ____5 Min ____10 Min
Socialization Habits: (mark all that apply)
____Plays rough ____Generally shares ____Can take turns ____Likes to play with others
____Plays well alone ____Affectionate
General Health Agreement:
Please do not expect our program to take care of sick children. If your child has a fever,
(100 degrees or greater) vomiting, diarrhea, an ear ache, sore throat, skin eruptions (rash, boils, ringworm, impetigo etc.) constant cough, red or runny eyes, runny nose with colored mucus, an acute cold, a respiratory infection, or in general feels “icky”---PLEASE keep your child at HOME!
Children should be free of all the above described symptoms for at least 24 hours, without the use of fever/pain suppressants, before returning to school. If children become sick during the school day, we will notify you to come pick them up. We will make sure your child is as comfortable as possible as they await your arrival.
NIT FREE is our policy; therefore if we suspect head lice we will contact you immediately to come get your child. A child must be nit free for at least 48 hours before returning to school.
I have read the above and will honor the program’s health policies.
Doctor’s Name _____________________________________ Phone #______________________
Signature_______________________________________________Date___________________
Emergency Treatment Release
In the event of an illness or accident that requires immediate medical treatment at a time when a parent/guardian cannot be reached, I give permission for Resurrection Kids to provide such emergency treatment to the best of their knowledge and ability. I will not hold the program or medical personnel responsible. This is done with the understanding that every attempt will have been made to contact a parent/guardian and other persons listed as emergency contacts.
I authorize staff members who are trained in the basics of first aid and CPR to administer the needed care to the best of their abilities. In the event of an illness or accident that poses imminent danger (seizure, head injury etc.) Resurrection Kids staff will call 911, for professional treatment. Every attempt will be made to contact a parent/guardian or a designated emergency contact.
Signature_____________________________________________Date_________________
Publish Request
I here-by give Resurrection Lutheran Church/Kids the absolute right and permission to publish, copyright and use pictures of my child/myself for the purpose of promoting the ministry programs of Resurrection Lutheran Church/Kids. I understand that no names will be used to identify children without the expressed permission of parents.
Signature____________________________________________Date_____________________
Discipline Policies:
A positive, welcoming atmosphere is maintained in the program. All children are welcomed and secure. If there is a need to correct or redirect a child’s behavior, the methods used are not humiliating, frightening, or physically harmful to the child. Discipline is based on the child’s level of understanding and directed toward teaching the child acceptable behavior. If a “time- out” or “thinking time” is used, their age is taken into consideration; (i.e. 1 minute per year of age.)
If a child insists on behavior that is unacceptable, disturbing or harmful to others, parent(s) will be contacted, and possibly asked to take their child home for the remainder of the day.
Biting policy: Due to the seriousness of a bite injury, the program is required to enforce a strict policy to ensure the safety of students and staff. The following school procedures are for children who bite another student or a staff member.
First and Second incident: parents are notified and asked to pick up the child immediately.
Third incident: parents are notified and asked to pick up the child immediately and the child will be expelled from school for two weeks.
Fourth incident: Parents are notified and asked to pick up the child immediately and the child will be expelled from school for the remainder of the semester. Parents may pay 50% of tuition to hold the child’s classroom slot so that he/she will have the opportunity to return at semester change.
I have read the above and will honor the program’s discipline policies.
Signature____________________________________________Date______________________
Financial Policies
There is a non-refundable registration fee of $100.00 per student. This fee accompanies your enrollment form to reserve space in our program.
Tuition is $22/27 per day and is due the first week of every school month. A $10 late fee will be added to tuition if received after the due date; additional late fees of $10 per week will accrue if tuition is more than one week late.
Before care and after care fees are $5.00 per session.
Parents/Guardians are responsible for reimbursing the program a $30 NSF charge due to a returned check.
I have read the above and will honor the program’s financial policies
Signature_____________________________________________Date____________________