NGMCA-Enrollment-Application 1Child2Knowing your child3Policy Statement4Emergency Care Release5Attendance6Physical Activity7Download Additional Forms Child's InformationChild's Name* First Middle Last Date of Enrollment MM slash DD slash YYYY Password* It is a word we will ask you if you request your child to be picked up by someone is not on the authorized list.Child's Nickname Child's Birthdate* MM slash DD slash YYYY Child's Gender* Female Male Child's First Language Child's Second Language Classroom*Select oneSeedlings (0 - 18 Months)Sprouts (1 - 3 Years Old)Saplings 1 (3 - 6 Years Old)Saplings 2 (3 - 6 Years Old)From:*Select Starting Hour7:00 am7:30 am8:00 am8:30 am9:00 amTo:*Select Pickup Time12:00 pm1:00 pm2:00 pm3:00 pm4:00 pm5:00 pm6:00 pmStarting Date MM slash DD slash YYYY Days of the Week in Care* Monday Tuesday Wedenesday Thursday Friday Parent/Guardian One information:Full Name Relationship to Child Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Email* Work Email Mobile Phone Number*Work Phone NumberHome Phone NumberEmployer Position Preferred Contact Cellphone Work Phone Home Email Work Email Child lives with: Authorized to pickup child: Yes No Parent/Guardian Two information:Full Name Relationship to Child Address same as parent 1*SameDifferentAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Email Work Email Mobile Phone NumberWork Phone NumberHome Phone NumberEmployer Position Preferred Contact Cellphone Work Phone Home Email Work Email Authorized to pickup child: Yes No Sibling InformationChild 1 Name Age Child 2 Name Age Child 3 Name Age Child 4 Name Age Legal StatusIf divorced, who has legal custody of child? *Copy of custody papers must be on file at New Generation Montessori Is there any other information you would like us to know?Medical AlertIs the Child require any:Medication:* None Yes If yes, explain:Please describe detailed information:Alergies:* None Yes If alergies Please explain:Please provide us detailed information on your child's alergies.Special Diet:* None Yes Explain:Medical Condition:* None Yes Explain Medical Condition:Assessment/Evaluation :* None Yes Explain:Is there any other information that would be helpful to our management and teaching staff?Health HistoryChild's Primary Care Physician Clinic Name/Location PCP/Clinic Phone NumberDate of last Exam MM slash DD slash YYYY Child's Dentist Name Dentist's Phone Number:Child's Health Insurance Company Policy Number: Emergency contacts and pick up authorizationChild will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason, the custodial parent or legal guardian cannot be reached:Full Name Relationship to Child Phone 1Phone 2Full Name Relationship to Child Phone 1Phone 2Full Name Relationship to Child Phone 1Phone 2Alternate Nutrition Plan AgreementARTICLE XII, B, PBC Rules require the parent and the center complete an ALTERNATE NUTRITION PLAN AGREEMENT if the meals or snacks are furnished by the child's parent. Indicate Special Dietary Requirements: I understand and approve the use of the Alternate Nutrition Plan. I agree to provide the following meals and/or snacks to meet my child's nutritional and dietary needs:Breakfast* Parent Provides Center Provides AM Snack* Parent Provides Center Provides Noon Meal* Parent Provides Center Provides PM Snack* Parent Provides Center Provides Evening Snack* Parent Provides Center Provides Dinner* Parent Provides Center Provides Formula* Parent Provides Center Provides Signature You will sign on this field in person. For now, leave it empty. Date MM slash DD slash YYYY Information to help us get to know your childDoes your child have strong likes or dislikes? If yes, please explain.*How does your child approach and respond to new situations?*What group/school experiences has your child been a part of?*Are there any concerns or challenges specific to your child?*Will your child need any special accommodations to be successful at New Generation Montessori?*Information to help us get to know your family*How did you hear about New Generation Montessori?Are there any family circumstances that would be helpful for us to know?*Is there anything you would like us to know about your family heritage, culture or ethnic background?*What is your family's experience with Montessori Education?*What do you value about Montessori education?*What are your expectations for your child’s education while at New Generation Montessori Children’s Academy?* Policy StatementMy child, (Enter your child's full name)* will be enrolled in the class:*Select oneSeedlings (0 - 18 Months)Sprouts (1 - 3 Years Old)Saplings 1 (3 - 6 Years Old)Saplings 2 (3 - 6 Years Old)and will be attending from:*Select Start Time7:00 am.7:30 am.8:00 am.8:30 am.9:00 am.to:*Select Pickup Time12:00 pm1:00 pm2:00 pm3:00 pm4:00 pm5:00 pmPlease read carefully the following policies:1. ARTICLE XV, B, 7, a, PBC Rules requires that parents must receive a copy of the Child Care Facility Brochure, KNOW YOUR CHILD'S DAY CARE CENTER. I have received a copy of the Child Care Facility Brochure, KNOW YOUR CHILD'S DAY CARE CENTER. 2. ARTICLE IV, C, 5, PBC Rules requires that parents be notified in writing of the disciplinary practices used by the child care facility. I have received in writing the disciplinary practices used by this child care facility. 3. ARTICLE XIII, B, 1, PBC Rules requires the parents complete an AUTHORIZATION FOR EMERGENCY MEDICAL CARE in the event of serious illness or accident and if the parents cannot be reached. I authorize the child care center to obtain emergency medical care for my child. 4. I have received a copy of the Influenza Brochure. 5. I hereby agree to comply with the rules, regulations and policies of New generation Montessori of Delray beach or “NGMDB” as indicated in the Parent Guide/Handbook. I agree that New Generation Montessori of Delray Beach has the right to terminate my child at any time during his enrollment. 6. I understand that I must provide a physical exam (Form 3040) and immunization record (Form 680 or 681) before child's start date. Your child's physician will provide the proper forms required by the State of Florida. 7. I agree to pay a non-refundable registration fee of $275.00. I understand that a re-registration fee is due every year thereafter. 8. I agree that if I pick up my child after his or hers scheduled program time, a late fee of $15 is calculated for any part of the first 5 minutes (1-5minutes late) and an additional $1.00 for any part thereafter. Repeated failure to pick up your child on time can result in enrollment termination. 9. I agree that no credit or makeup days will be granted for absences, illnesses, vacations, emergencies/weather related emergencies or holiday closings. Full tuition is always due "No Exceptions" will be made. 10. I understand that program times have been put in place. Your child is considered late after 9:00am. Repetitive tardiness will not be accepted 11. I agree not to bring my child to school if he/she is showing any signs of illness. I understand that if my child is showing signs of illness, I must have set arrangements for a quick pick up. I agree to keep my child out of school no less than 24 hours after and provide NGMDB with a doctor's note authorizing child to return to school free of illness 12. I understand NGMDB has a PRESCRIPTION ONLY MEDICATION ADMINISTERED POLICY. 13. I understand NGMDB has a strict mandatory uniform policy for ages (1-year-old and older) and must be followed every day. 14. I understand NGMDB has the right to change policies, prices and procedures with proper notice. 15. I agree to pay all the costs and expenses incurred by the center, including court costs and reasonable attorney fees if it becomes necessary to take action and enforce this agreement. 16. PARENT HANDBOOK: I agree to all of the above-mentioned policies as well as the Parent Handbook/Guide of which I have received a copy.Child Care Facility Brochure, KNOW YOUR CHILD'S DAY CARE CENTER. Download it here: C. NGMDB Know your childcare Influenza Virus Brochure. Download it here: D.-NGMDB Influenza Signature Parent/Guardian 1 You will sign on this field in person. For now, leave it empty. Signature Parent/Guardian 2 You will sign on this field in person. For now, leave it empty. Emergency Care ReleaseName, Lastname of the Child I Give permission to the staff of New Generation Montessori to call “911” for emergency treatment of to my child listed above, in the event of an emergency at which I cannot be reached, I give consent to transport by ambulance if situation warrants it. I also give permission to the emergency personnel to administer first aid and to transfer my child to a hospital.Name of parent:* Yes/No*Select one answerYes, I authorizeNo, I don't authorizeDate* MM slash DD slash YYYY Authorization for Media ReleaseI acknowledge that New Generation Montessori of Delray Beach is a private provider and understand that my child’s picture may appear on their printed newsletter, website and social media channels as part of a media publication on New Generation Montessori of Delray Beach.I have read the above and hereby give my consent: Yes No Discipline PolicyOur form of discipline for children 1 to 5 years old is to redirect the child to another activity or area. If the child becomes uncooperative we then separate him or her from the other children. We may sit the child on a chair away from the group; discuss what she or he has done that is disturbing to the class. The child may join the others when she or he feels ready to behave properly. If the behavior is continual, then a conference shall be established with the parent or guardian.I have read the above and hereby give my consent:* Yes No Attendance & Sick Student PolicyPlease remember it is REQUIRED to keep your child at home if the following conditions exist: • A fever of 100.5 or above • A skin rash that has not been identified by a phone call or in writing by a doctor • Diarrhea and or vomiting two or more times in a day • Evidence of head lice (without proof of treatment) • Severe coughing or excessive runny nose • Conjunctivitis (pink eye) • Sore throat or difficulty swallowing • Stiff neck • Infected skin patches • Pain of which the child complains and interferes with normal activity • Evidence of infection • Excessive fatigue • A moist or open sore Children ill because of communicable diseases must have a written statement from a doctor stating that they are no longer contagious before returning to school. All children sent home must be symptom free for 24 hours per the child care ordinance before returning to school. Excused Absences: 1. Medical appointment of child or another family member 2. Any Illness or communicable disease listed below 3. Family emergency (may include car accident, lack of transportation, death of family member, catastrophe) 4. Severe weather conditions that prohibit travel to and from school 5. Official or legal agency appointments (immigration, court appearance, etc.) 6. Court-ordered visitation 7. Religious/cultural celebrations Unexcused Absences (Limited to 10 per fiscal year) 1. Preschool child did not want to go to school 2. Parent/child overslept 3. Any absence for which a specific reason is not givenParent Name* I have read the above and hereby I acknowledge and accept this policy:Child's Name* Date* MM slash DD slash YYYY Physical Activity PolicyStudents at New Generation Montessori of Delray Beach will play outdoors daily when weather and air quality conditions do not pose a significant health risk. Time planned for outdoor play and physical activity depends on the age group and weather conditions. Activities shall include structured play and free play. Students ages one to five shall participate in a minimum of 30 minutes per day of moderate to vigorous physical activity. Samples of physical activities: (indoor, outdoor) • Use music for stepping, hopping, jumping in place. • Have kids make up dances or share the latest popular or line dances. Play “keep the ball up”. Use one ball per child or one ball per small group. The group may add additional balloons as they gain control and awareness. • Play "fitness with the leader." This is "follow the leader," using exercises. • Measure heart rates after various movements (hop, walk, jump, skip, etc.). • Make up "hand jive" routines, share and teach to others. • Try juggling, top spinning, or yo‐yo contests. • Sport mimics: act out sport movements such as batting, kicking, dribbling, throwing/catching, dunking, swimming various strokes, and volleyball passing/serving. Everyone is skillful without the equipment!! Dress policy for physical activity: • Children shall be dressed appropriately for the weather, including wearing appropriate seasonal clothing and footwear, so they can participate fully, move freely, and play safely. • Footwear should provide support for running and climbing. Examples of appropriate footwear include sneakers, gym shoes, and other shoes with rubber soles that enclose the feet and will not come off easily. Examples of inappropriate clothing and footwear include: • Footwear that can come off while running or that does not provide support for climbing (examples: flip-flops and clogs). • Clothing that can catch on playground equipment (examples: clothes with drawstrings or loops).Parent Name* I have read the above and hereby I acknowledge and accept this policy:Child's Name* Date* MM slash DD slash YYYY Download Forms Thanks for completing the online forms. Now please download the following document, print it and bring it with you when you come to sign and complete your registration. Download it here: Sumplementary Documents. Please download, fill out using acrobat reader and print. Now that you have downloaded the supplementary document, you can submit your application with button below. Thank you!
