Infant Room Enrollment Application


Student/Child Information
Name:
Date of Birth: Age: Gender:

Parent Information
Mother's Name:
(Or guardian)
Home Address: Home Phone:
  Email Address:
     
Work Address: Place of Business:
  Work Phone:
     
Father's Name:
(Or guardian)
Home Address: Home Phone:
  Email Address:
     
Work Address: Place of Business:
  Work Phone:
     

Enrollment Schedule & Tuitions - There is a $75 registration fee that will be added to the first month billing.

Parents will be billed monthly according to the enrollment program you select. Monthly payments are due in full by the 1st. A late fee of $25.00 will be charged if payments are not received by the 5th of every month. If payment is not received by the 8th an additional $5 per day will be added to the bill until it’s paid in full. It is family’s responsibility to make sure payment is made even if your child’s regular schedule day doesn’t fall on the 1st or if you plan to be out of town. Payments can be dropped off in the drop box or paid online.

Enrollment Options:
Half-Day Tuition ~$37.00 per day. 2 Options Please choose one:

Monday     Tuesday     Wednesday     Thursday     Friday    

3/4 – Day Tuition~$47.00 per day. 7:45-3:30

Monday     Tuesday     Wednesday     Thursday     Friday    

Full-Day Tuition~$57 per day. Drop off between 7:45-9:30   Pick-up is by 5:30

Monday     Tuesday     Wednesday     Thursday     Friday        

Indicate Date on which you would like to initiate enrollment:
(Enrollment date will depend on availability)
Day Month Year
Desired Location:

Parents must give two-week notice of any Schedule Changes. Parents are responsible to fill out all proper paper work before attendance is allowed. Parents must keep all records and forms up to date. A visit with parents/guardians and child are required before the child attends Little Learners. This meeting can be made with the director.

Parent/Guardian Signature: Date:
Director Signature: Date:

NEEDS & SERVICES PLAN


Infant Care Program
Breast Milk/Formula Combination of?
(Please keep an extra 6 pack or a can at school)

My baby has bottle every hours and takes approximately ounces

My baby needs to be burped times during feeding

I will be in to nurse my baby every hours or at time.

May water be fed between nursings or bottle feedings?


Solid foods
Food likes and dislikes:
Food consistency:
Schedule for introduction of solid foods and new foods:
Food Allergies:

Details and Schedule
Eating:
Sleeping:
Playtime:
Allergies:

DAILY SCHEDULE


Naps :

My baby naps for approximately hours/minutes

Between & A.M.

My baby naps for approximately hours/minutes

Between & P.M.

How does your baby get to sleep? (Rocking,eating,fuss a little,pacifier?)  

What other information can you give us to better care for your baby?

Parents Signature:

 

Date:

 

Parents Signature:

 

Updated:

 

Parents Signature:

 

Updated:

 
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