ST. LAWRENCE

CHILD CARE CENTER

2200 N.E. 191 STREET

NO. MIAMI BEACH, FL 33180

305-932-5366

 

 

INFORMATION SHEET

A.  FAMILY:                                                                  REGISTRATION DATE:_______________

 Child's Name:__________________________________Birthdate:_________________

Address:______________________________   City:_______________Zip:___________

Mother's Name:________________________  Home Phone: (      )_________________

Address:_______________________________City:_________________Zip:_________

Cellular:_______________________________ Work Phone:______________________

Employer Name:________________________ Type Of Work:_____________________

Employer Address:_______________________________________________________

Drivers License Number:__________________ Email:___________________________

Father's Name:________________________   Home Phone: (      )________________

Address:_______________________________ City:_____________Zip:____________

Cellular:________________________________Work Phone:_____________________

Employer Name:_________________________Type Of Work:____________________

Employer Address:_______________________________________________________

Drivers License Number:___________________Email:___________________________

Are You A Member Of St. Lawrence Parish: No___ Yes____ Envelope#_____________

If Not, In Which Parish Are You A Member Of:_________________________________

 

B: PICK UP AND EMERGENCY

PERSONS TO WHOM THE CHILD IS TO BE RELEASED:

1. Name:________________________Address:_________________________________

    City:___________ State:_________ Zip:_______Relation:______________________

    Home Phone: (        ) ______________ Work Phone: (         )_____________________

2. Name:________________________Address:________________________________

    City:___________ State:_________ Zip:_______Relation:______________________

    Home Phone: (        ) ______________ Work Phone: (         )_____________________

IN CASE OF EMERGENCY, PERSONS TO CONTACT OTHER THAN PARENT:

1. Name:________________________Address:_________________________________

    City:___________ State:_________ Zip:_______Relation:______________________

    Home Phone: (        ) ______________ Work Phone: (         )_____________________

2. Name:________________________Address:________________________________

    City:___________ State:_________ Zip:_______Relation:______________________

    Home Phone: (        ) ______________ Work Phone: (         )_____________________

FAMILY PHYSICIAN:_______________________ PHONE:(         )___________________

ADDRESS:______________________________________________________________

 

 

C. GET ACQUAINTED INFORMATION:

1. What are your child's favorite toys:________________________________________

2. Does your child have a pet:______ If so, what:_______________________________

3. How many hours a day does your child watch T.V:____________________________

    What programs does She/he View_:_______________________________________

4. What foods does your child enjoy:_________________________________________

5. What is the usual bed time hour:__________________________________________

6. Does your child have any habits, such as Thumb sucking, Nail biting, or other? Please describe:_________________________________________________________

_______________________________________________________________________

7. Does your child have any particular fears or nightmares:_______________________

_______________________________________________________________________

8. Does your child use any expressions that may not be understood by others ( such as Wee-Wee for Urine):___________________________________________________

9. What is your usual method of reassuring and rewarding your child:______________

_______________________________________________________________________

10. What is your "Philosophy" of disciplining your child:_________________________

11. Does your child have any allergies:________________________________________

12. Is your child under any medication or therapy:______________________________

13. Was your child premature, and if yes, by how much:_________________________

 

PLEASE LIST NAMES, RELATIONSHIPS, AND AGES OF BROTHERS AND SISTERS AND OTHER MEMBERS WHO LIVE IN THE HOME.

Name:_________________________ Age:______ School:________________________

Name:_________________________ Age:______ School:________________________

Name:_________________________ Age:______ Relation:______________________

Name:_________________________ Age:______ Relation:______________________

 

FIELD TRIPS

I understand that I will be notified of field trips, and that my child will be taken from school ground on these excursions ( 3 and 4 year olds ONLY). I give my permission for (child's name)__________________ to accompany the Class.

 

Mother's Signature:____________________Father's Signature:__________________

 

 

 

 

D. HAVE THERE BEEN ANY MAJOR CHANGES IN THE FAMILY, SUCH AS SEPARATION, DIVORCE, DEATH, ILLNESS, OR MOVING:_____________________________________

______________________________________________________________________________________________________________________________________________

 

Please list anything else about your child that you think we should be aware of in School:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

​

ST LAWRENCE CHILD CARE CENTER CHECK LIST FOR READINESS

 

Child's Name:___________________________________________________________

Child's Date of Birth:_____________________________________________________

 

Please Check all that applies to your Child:

 

(    ) Toilet Trained                       

(    ) Feeds Self

(    ) Needs Help Feeding Self

(    ) Eats Almost All Foods

(    ) Eats Very Few Foods

(    ) Has Temper Tantrums

(    ) Teases Other Children

(    ) Overactive

(    ) Highly Excitable

(    ) Timid and/or Shy

(    ) Plays Well With Others

(    ) "Picked on" By Others

(    ) Overly Aggressive

(    ) Cries Easily                       

(    ) Has Many Fears

(    ) Has Few Interests

(    ) Has Many Interests

(    ) Is Attentive

(    ) Cares for Own Property

(    ) Follows Requests

(    ) Initiates Own Actions

(    ) Speech Impediment (Explain)

(    ) Does not Speak (Explain)

(    ) Speaks in Sentences

(    ) Seldom Speaks

(    ) Speaks Understandably

 

(    ) Does your Child speak English, if No, which language:____________________

 

USE THE BACK OF THIS PAPER TO EXPLAIN IF NECESSARY

 

My Child needs to:

 

(    ) Become Self-Reliant                       

(    ) Get interested in something

(    ) Become Cooperative

(    ) Adjust to other children

Other:________________________________

(    ) Acquire Manual/Motor Skills                      

(    ) Relax

(    ) Become Less Active

(    ) Become More Active

 

Comments:____________________________________________________________________________________________________________________________________

_______________________________________________________________________

 

Signature of Parent/Guardian:________________________________

                                             Date:________________________________

 

 

 

​

PARENT CONTRACT

 

 

I have read and agree to comply with the policies stated in the Parent Handbook.

 

I agree to pay at the rate specified in the Handbook. I understand that the Registration Fee is NON-REFUNDABLE . I understand that the Payments are due on MONDAY, and that LATE FEE of $5.00 per day will be CHARGED if payments is not received by TUESDAY.

 

I understand that failure to comply with tuition policies can result in my child being REMOVED from the Center.

 

I agree to pay a LATE PICK-UP FEE of $10.00 every 15 minutes or any part of 15 minutes after 6:00pm per child.

Part-Time students left after 2:30 pm will incur a LATE FEE of $10.00 every 15 minutes or any part of 15 minutes per child.

Half-Time students left after 12:00 pm will incur a LATE FEE of $10.00 every 15 minutes or any part of 15 minutes per child.

 

 

Signature of Parent/Guardian:________________________________

                             Child's Name:________________________________                                            

                                            Date:________________________________

 

 

 

 

CHILD DAY CARE LICENSING                        ALTERNATE NUTRITION PLAN AGREEMENT 

 

 

 

Name of Facility:  St Lawrence Child Care Center   

Name of Child: ____________________________________ Age: ­­­__________________

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:

 

 

(Mark P for Parent Provides, or C for Center Provides)

 

​

 

 

Breakfast       A.M. Snack      Noon Meal       P.M. Snack      Dinner       Evening Snack       Formula

 

 

 

_____________________                                                          ________________________

Date                                                                                                Signature of Parent

 

 

I agree to provide the parent with a suggested meal pattern and menus and to discuss any problems which might develop in the use of the Alternate Nutrition Plan.

 

 

_____________________                                                           _________________________

Date                                                                                                Signature of Owner/Operator

 

 

HRS-CYF Form 5019, May 82 (Replaces HRS-SES Form 4084; obsoletes DFS-S-2052) (Stock Number: 5749-000-5019-4)

 

 

 

 

 

 

 

 

 

 

 

ST. LAWRENCE

CHILD CARE CENTER

2200 N.E. 191 STREET

NO. MIAMI BEACH, FL 33180

305-932-5366

 

 

 

EMERGENCY PROCEDURE CARD

                                                                                                                     

                                                                                                                     Date:________________

Student Name:_____________________________________   Age:________________

Address:___________________________________________Zip:_________________

Home Phone:_________________________

 

Mother's Business Name:____________________________________________________

Address:________________________________________________________________

Phone:________________________  Cell Phone:_______________________________

 

Father's Business Name:___________________________________________________

Address:________________________________________________________________

Phone:________________________  Cell Phone:_______________________________

 

IF PARENTS CANNOT BE REACHED, CALL:

____________________________________ Phone:_____________________________

____________________________________ Phone:_____________________________

 

PHYSICIAN:____________________________Phone:___________________________

 

Please list anything about your child that you think we should be aware of in school

( Allergies, Fears, etc...)___________________________________________________

______________________________________________________________________________________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

ST. LAWRENCE

CHILD CARE CENTER

2200 N.E. 191 STREET

NO. MIAMI BEACH, FL 33180

305-932-5366

 

 

Please Print:

 

Student Name: ____________________________________________

 

Birth Day: _________________________________________________

 

 

______Right Handed     ______ Left Handed      ______Uncertain

 

 

Please select you choice:

 

_______ I will provide Lunch for my child

 

_________ I will pay the weekly Lunch fee that is served

_______with Milk   OR  ______with Juice

 

My child will be:

 

________ Full Time Care (7:30 – 8:30 drop-off & picked up by 6:00pm)

________ Part-Time Care (7:30 – 8:30 drop-off & picked up by 2:30pm)

               ________ VPK 3 Hours (9:00 am drop-off & picked up by 12:00pm) 

 

Allergies or Concerns:

 

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

ST. LAWRENCE

CHILD CARE CENTER

2200 N.E. 191 STREET

NO. MIAMI BEACH, FL 33180

305-932-5366

 

 

 

DISCIPLINE POLICY

 

 

We are required by Children and Families to provide parents with a written discipline policy.  This policy needs to be signed and returned to our office and will be kept in the student file.

 

Our program will insure that age-appropriate, constructive disciplinary practices are used for your child.  This care will allow the child time to look over his or her behavior.  We will encourage children to choose alternatives to improper behavior. To insure a safe and successful program, discipline is a must.  We welcome the ideas of parents, so feel free to share them with us.

 

The following steps will be used for behavior modification:

1st- Children will be corrected and asked to change their behavior

2nd- Children will be re-directed from the situation

3rd- Children will be placed in “Time Out”

4th- Parents will be contacted if behavior is not corrected

5th- Children will not be subject to discipline which is severe, humiliating or  

        frightening

6th- Discipline shall not be associated with food, rest, or bathroom needs.

7th- Spanking or any other form of physical punishment is prohibited.

 

 

 

I, _____________________ have received in writing the disciplinary practices used by

St. Lawrence Child Care Center.

 

 

_______________________________________

Signature of Parent or Guardian

 

______________________________________

Student Name

 

 _______________________________________

Date

 

 

 

ST. LAWRENCE

CHILD CARE CENTER

2200 N.E. 191 STREET

NO. MIAMI BEACH, FL 33180

305-932-5366

 

 

 

 

Dear Parents,

 

In an ongoing effort to abide by the rules and regulations of the Department of Children and Families, we are required to have the parents' sign a release allowing St. Lawrence Child Care Center to take pictures and/or video of the children for our photo album to display the pictures in the classroom, and/or website.

 

I understand that my child may be photographed and/or videotaped at various school events and/or activities. As such, I give my consent to St. Lawrence Child Care Center so that above mentioned can be released for use by St. Lawrence Child Care Center and St. Lawrence Catholic Church.

 

Thank you for your cooperation,

 

 

Ms, Iliana Medolla

Director

 

 

 

Would you agree to have your child's photo displayed in our photo album, website or classroom? _______Yes   ________No

 

 

Student's Name:___________________________________

Parent's Name (Print):_______________________________

Parent's Signature:_________________________________

Date:__________________

 

 

 

 

ST. LAWRENCE

CHILD CARE CENTER

2200 N.E. 191 STREET

NO. MIAMI BEACH, FL 33180

305-932-5366

 

 

 

 

 

Dear Parents,

 

We are in the obligation to remind you NOT TO LEAVE YOUR VALUABLES IN THE CAR while picking up your child from our center.

 

When we say "valuables" we mean,

• Purses/Wallets

• Laptops

• Gym Bags

• Packages, etc..

 

We also want to remind you, not to leave your older children in the car while coming inside the Center. We advice all the parents to use the car trunk to place the valuables, and anything you can carry in your car that you consider might attract the attention of criminals.

 

Please, take this matter seriously, and help us prevent the wave of crimes in our area, and remember, WE DO NOT PROVIDE SECURITY PERSONNELL IN THE PARKING LOT, we do have security cameras, but our main and most important concern is the well being of your children, your belongings are your responsibility.

 

Thank you for your cooperation,

 

 

Ms, Iliana Medolla

Director