Start Your Child's Application

Your First Name

Your Last Name

Your Email Address

Number of Children You Are Applying For

1 child

2 children

3 children

I am the parent, step parent, or legal guardian of the children that are applying.

Yes

Child 1

First Name

Last Name

Gender

Male

Female

Date of Birth

Child's Primary Residence

Both Parents

Mother

Father

Legal Guardian

Is your child toilet trained?

Yes

No

Is your child able to walk?

Yes

No

Can your child effectively communicate his or her needs?

Yes

No

Is your child's primary language English?

Yes

No

Please explain any "No" answers to the 4 questions above:

Child 2

First Name

Last Name

Gender

Male

Female

Date of Birth

Child's Primary Residence

Both Parents

Mother

Father

Legal Guardian

Is your child toilet trained?

Yes

No

Is your child able to walk?

Yes

No

Can your child effectively communicate his or her needs?

Yes

No

Is your child's primary language English?

Yes

No

Please explain any "No" answers to the 4 questions above:

Child 3

First Name

Last Name

Gender

Male

Female

Date of Birth

Child's Primary Residence

Both Parents

Mother

Father

Legal Guardian

Is your child toilet trained?

Yes

No

Is your child able to walk?

Yes

No

Can your child effectively communicate his or her needs?

Yes

No

Is your child's primary language English?

Yes

No

Please explain any "No" answers to the 4 questions above:

Child's Primary Residence

Address

Address Line 1

Address Line 2

City

State

Zip Code

List the family members your child lives with. Include names and ages of siblings.

Is there a parenting plan in place for your child?

Yes

No

Please upload your parenting plan.

Choose File

Parent/Guardian #1

First Name

Last Name

Employer

Position/Title

Business Phone

Mobile Phone

Best Contact Email

Same Home Address As Child?

Yes

No

Address of Parent/Guardian #1

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #2

First Name

Last Name

Employer

Position/Title

Business Phone

Mobile Phone

Best Contact Email

Same Home Address As Child?

Yes

No

Address of Parent/Guardian #2

Address Line 1

Address Line 2

City

State

Zip Code

Other Release Persons

Do you plan to have anyone other adults drop off or pick up your child from our care other than the parents/guardians already listed?

Yes

No

Other Release Person #1

(required if you answered Yes)

First Name

Last Name

Phone/Mobile

Relationship to Child

Other Release Person #2

(optional)

First Name

Last Name

Phone/Mobile

Relationship to Child

Medical and Emergency Contact Information

Physician's Name

Physician's Phone Number

Physician's Office / Place of Business

Physician's Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Preferred Hospital/Clinic for Acute Care and Emergency Care

Dentist Name

Phone/Mobile

Allergies and Medication

Special dietary needs:

Allergies to drugs, food, or other:

Are any of the allergies severe or life-threatening?

Yes

No

If yes, please provide special instructions:

Does your child take any medication that will be administered regularly at the school?

Yes

No

If yes, please explain:

Fees & Payments

PAYMENT OF FEES: I understand that fees are due and payable, on the first day of attendance each week. Appropriate alternate fees must be paid during school breaks.

I agree

CHARGES & PROCEDURES FOR LATE PICK-UP: My school is open from 5:30 am to 5:30 pm, Monday through Friday all year, except for holidays. I understand that if I fail to pick up my child by the scheduled closing time, I will be charged a late fee of $3 per minute per child, until the child is picked up.

I agree

ADDITIONAL FEES: School age camp will be open during the summer months and during scheduled school breaks according to the local public school calendar. Summer Camp children and children attending during scheduled school breaks may pay a separate Activity Fee for attendance. All other age groups may be subject to Activity Fees as well. In instances of agency reimbursement, Activity Fees may be my responsibility. Please consult the Director for details.

I agree

RETURNED CHECKS: I understand that a processing fee will be charged to my account for all checks which are returned for any reason, and this fee is in addition to any charges that my bank or financial institution may charge me. Iunderstand that any non- sufficient funds checks will be automatically resubmitted electronically up to three times. I further understand that once a check has been processed electronically, the check is no longer negotiable and will not be returned. If more than two checks are returned within a six-month period, I will be required to pay by an alternate method of payment for the next six-month period. The maximum fee allowed by state law will be charged for all returned checks. I am responsible for the principal amount plus all returned check fees.

I agree

Daily Procedures

DAILY SIGN-IN AND SIGN-OUT: I agree to sign my child in and out every day using the school's attendance procedure. If I neglect to do so, I may be charged a maximum fee of $5.00 per missed sign-in or sign-out. I understand that my child is not permitted to sign him/herself out. I understand that I am required to enter the school to drop off and pick up my child and that I must escort my child to and from the designated classroom and staff member each day. In states where a manual signature is required due to state child care licensing regulations, I agree to complete the required computer and manual sign-in and sign-out procedures.

I agree

ILLNESS: I understand that I will be notified should my child become ill during the day, and that I will pick up my child promptly, or make arrangements for an authorized emergency contact person to pick up upon such notification. If my child is exposed too or contracts a contagious disease, I agree to notify the school and Iunderstand that my child will be readmitted according to the Re-admission Criteria in the Family Handbook.

I agree

MEDIA RELEASE: The company, its agents, affiliates, and licensees, may use photographs, reproductions, images or sound recordings of my child for advertising, publicity or any other lawful purpose.

I agree

PHOTOGRAPHS, VIDEOS AND AUDIO TAPES: I understand and agree that, in consideration for being allowed to photograph, videotape or audiorecord my child on company property, Ishall only usesuch recording for lawful and private home use, and will not publish, publicly display or sell such recordings. I also understand that I must have written permission before capturing any image of the other children in the school or staff.

I agree

INTERVIEWING CHILDREN AND INSPECTING RECORDS: I understand that the state child care regulatory enforcement and administration agency and the local department of social services or child protective services has the authority to interview children or staff, to inspect and audit child or facility records, to interview children privately, to observe the physical condition of the children in the school, to make provisions for the independent medical examination by a licensed physician of any child, and to contact and instruct any other appropriate authority to do the same without prior notice or consent by myself of the school.

I agree

WITHDRAWAL FROM PROGRAM: I understand that I must provide a two (2) week written notice of withdrawal from the program. If this notification is not provided, I agree to pay all tuition and fees for two (2) weeks, whether or not my child attends. I understand that when my child is withdrawn, s/he will only be eligible for re-admission based upon space availability and all other enrollment criteria. If my child is selected for re-enrollment, I will be required to complete an entire new Enrollment Agreement at the current rate and pay a new non-refundable Registration Fee at the current rate. If there is an outstanding balance (including tuition or fees) when my child was withdrawn, I will be required to bring my account current prior to completing a re-enrollment application. I understand all fees (Tuition, Registration or Activity) are non-refundable.

I agree

Holidays, Absences and Closings

HOLIDAYS: I understand that the school is closed on al State of Tennessee Holidays: New Year's Day, Martin Luther King Day, President's Day, Good Friday, Memorial Day, Independence Day, Labor Day,Veterans Day, Thanksgiving Day and the day after, Christmas Eve and Day, New Year's Eve. I agree that I will not receive a refund, credit or any other allowance for holidays. If a holiday falls on a weekend, it will be observed on either the preceding Friday or the following Monday. We will be closed for two teacher development days per year.

I agree

ABSENCES/VACATIONS: I understand that no allowances, credits, refunds, or make up days shall be made for occasional absences (i.e. sickness. My regularly contracted tuition is due for all weeks when my child is enrolled . . There is no credit given for single days. I also understand that if I withdraw my child during a vacation, I will be required to pay a new non-refundable registration fee upon return.

I agree

EMERGENCY CLOSING AND INCLEMENT WEATHER INFORMATION: I understand that it is the company's intention to be open and provide childcare service every weekday of the year, excluding holidays, but that inclement weather, natural/national disaster or major building issue may disrupt service from time to time. I will contact the school to ensure that it is open during inclement weather/natural disaster. I agree that in the event that the school is closed for an extended period of time, I will continue to be responsible for my tuition payments for up to fourteen business days.

I agree

State Licensing and Policies

ALL POLICIES & STATE REGULATIONS: I understand that the above policies are not an all-inclusive list of policies, and that state child-care regulations, the FamilyHandbook, and all other company policies, which may be modified at any time, without notice, bind my child, my family members, authorized agents and me. Ialso understand that the child-care regulations of the state in which my child attends may prevail over these policies when the state regulation is stricter. I further understand that my continued enrollment constitutes my acknowledgement of, and agreement to abide by, all Policies and state regulations.

I agree

FAMILY HANDBOOK: I have received a copy of the Family Handbook. I have read and understand its contents and policies and agree to be bound by same.

I agree

NO MODIFICATIONS: No terms of this Agreement may be altered, revised, modified or deleted by any person except in cases of policy change or rate change to which both the Director and I must initial. Any alterations, revisions, modifications or deletions of any term of this Agreement are null and void.

I agree

Spring Hill Early Learning does not discriminate based on disability in the admission/enrollment or access to our programs or services. Information concerning the provisions of the Americans with Disabilities Act (ADA), including the rights provided thereunder, is available from the Director. These policies have been reviewed with me by school management. I understand and will comply with the policies included in the Enrollment Agreement and Family Handbook. The policies in this contract will supersede all other previous documents.

I agree

Signature of Parent/Legal Guardian

I certify that this application is true and correct. I understand that my application is not complete until the registration fee is paid for each child.

*You will be taken to a payment page to pay the registration fee after submitting this application.

Signature

Sign Here

Date

First Name

Last Name

Student Application

Start Your Child's Application

Child 1

Child 2

Child 3

Child's Primary Residence

Parent/Guardian #1

Parent/Guardian #2

Other Release Persons

Other Release Person #1

Other Release Person #2

Medical and Emergency Contact Information

Allergies and Medication

Fees & Payments

Daily Procedures

Holidays, Absences and Closings

State Licensing and Policies

Signature of Parent/Legal Guardian