Online Enrollment Form
Admission Information
Directions: The parent or guardian must fill out this form entirely and must return it to the facility no later than the morning of the child’s first day of enrollment. We will keep these forms on file in the facility and will be updated by the parent as needed by SMA to comply with Texas Childcare Licensing Minimum Standards. Written forms must be completed in blue or black ink only.
Child's Information:
Parent/Guardian Information:
Primary Account Holder:
This parent or guardian will be the main account holder for all the payment information. Any ledger cards, tax forms, and receipts will be in the primary account holder's name. Custody Documents On File
Parent or Guardian Primary Emergency Contact Information
This parent or guardian with whom we can get in contact with quickly in case of an emergency.
Emergency Contact Information
Must be other adult besides the parents or guardians.
Authorized Pick Up The Child
One may be the same as the emergency contact. The authorized pick person must be other adults besides parents.
I authorize DeSoto Children's Academy to release my child to leave the facility ONLY with the authorized persons listed above. Children will only be released to a parent or guardian or person designated by the parent or guardian after verification of identification.
Authorization For Emergency Medical Attention
In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:
I give consent for DeSoto Children's Academy to secure any and all necessary emergency medical care for my child and I will be responsible for the applied costs:
Authorization For Emergency Medical Attention
List any special problems that your child may have, such as environmental allergies, food intolerances, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months and from birth of the child. Any medication prescribed for long-term continuous use and any other information which caregivers and management should be aware of: Does your child have a doctor diagnosed food allergy? Plan submitted on: (office use only)
Child care operations are public accommodations under the Americans with Disabilities Act (ADA), Title III. If you believe that such an operation may be practicing discrimination in violation of Title III, you may call the ADA information line at (800) 541-0301 (voice) or (800) 514-0383 (TTY).
Consent Information
Please consent to all that apply.
1. TRANSPORTATION: I hereby __ my consent for my child to be transported and supervised by DeSoto Children's Academy employees.
2. FIELD TRIPS (ages 5 thru 12): I hereby __ my consent for my child to participate in field trips.
3. WATER ACTIVITIES: I hereby __ my consent for my child to participate in water activities. Sprinkler play during summer time
Meals
DeSoto Children's Academy is currently enrolled in the Federal Food Program through the Texas Department of Agriculture and will serve the following meals to your child: Breakfast, Lunch and Afternoon Snack.
Schedule
Part Time students will need to sign up for the same days each week and will only be able to change or substitute upon director approval. Not all requests will be approved
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
School Age Children
My child attends the following school
Authorized Pickup/drop off locations other than the child's address:
My child has permission to:
Admission Requirements:
If your child does not attend pre-kindergarten or school away from Sunshine Montessori Academy, the following must be provided: Shot Record: We must receive an updated shot record to be placed in your child’s file every time your child gets a vaccination. If your child is not current with licensing standards, we will not be able to care for your child until they are up to date. Physician Statement: We have provided a physician form for your child’s doctor to fill out and sign to be placed in your child’s file. Form must be filled out completely and a stamp from the doctor’s office included in the designated spot. This form must be submitted within one week of your child’s first day of enrollment. Vision and Hearing Screening: The results of your child’s vision and hearing test must be submitted to be placed in their file once your child turns four years old.
Admission Requirements:
I have attached a signed and dated affidavit stating that I decline immunization for reason of conscience, including religious belief, on the form described by Section 161.0041 Health and Safety Code submitted no later than the 90th day after the affidavit is notarized.
I have attached a signed and dated affidavit stating that the vision or hearing screening conflicts with the tenets or practices of a church or religious denomination that I am an adherent or member of.
Varicella (chickenpox) vaccine is not required if your child has had chickenpox disease. If your child has had chickenpox, please complete the following statement:
Gang Free Zone
Under the Texas Penal Code, any area within 1,000 feet of a childcare center is a gang-free zone, where criminal offenses related to organized criminal activity are subject to harsher penalties.
Gang Free Zone
Under the Texas Penal Code, any area within 1,000 feet of a childcare center is a gang-free zone, where criminal offenses related to organized criminal activity are subject to harsher penalties.
Attach Completed Documents
PLEASE FILL OUT THE PHYSICIAN STATEMENT AND FOOD ALLERGY EMERGENCY PLAN AND ATTACH THE COMPLETED DOCUMENTS (These forms are located at the bottom of this form.)
For Office Use Only:
Date of Enrollment
Director:
Date of Disenrollment
Director:
Submit Enrollment Forms
Thanks for submitting your enrollment application. Someone from our office will contact you soon.
.png)
