2012 Handbook

Pumpkin Patch Daycare Handbook


Please read this 2012 handbook thoroughly, as it covers very important policies and procedures that not only govern our childcare contract agreement, but also pertain to the care of your child. There may seem to be a lot of information, if you have any questions regarding my policies, please do not hesitate to ask. This copy is for you to keep and reference back to. There will be a yearly revision to this handbook and the accompanying contract. All families will sign a new contract each year. I reserve the right to make changes to the policies and procedures, as I deem necessary. You will be notified, in writing, of any changes that may occur.



DEAR PARENTS,

What I as a provider should expect from you, the parents: Open communication. Explain clearly and carefully your wishes and expectations about how your child will be cared for. Also provide updates on problems and progress that your child is making. Good communication helps us work together in the best interest of your child. If a child is changing their nap or food habits please mention it to Pumpkin Patch DC so we can better meet the needs of your child.

Agreement on Terms of Arrangements: You should fully understand the terms of the contract and the policies and procedures that you as the parent are agreeing to, always feel free to ask questions.

Honesty & Trust: This includes being honest about how you believe the arrangement is working. Although you need to be vigilant in order to safeguard your child, you should trust me as your childcare provider to do the best for your child. Show your trust by asking questions rather than jumping to conclusions when apparent problems develop.

Pick up on time: I, as your provider, have a personal life too. No trip to the grocery store etc on your way here without prior notice, just because you find it more convenient. Ultimately the care of your child is your responsibility.

Respect: Realize that taking care of children is a job and that not only am I a worker, but also a working parent. Recognize that this is not an easy job, I am not ‘just a baby-sitter.’ Last, but not least, I am only human; I am not ‘superwoman,’ please do not expect me to do things that you yourself would not do.

Philosophy: We believe a child’s early experiences enrich and stimulate future growth. Children deserve to be treated and respected as individuals in an environment that welcomes reason, exploration, question, and imagination. We respect each child’s need for love, security, acceptance, warmth, and stimulation.

Goals: While in my care your child will have the opportunity to participate in activities which promote all aspects of development. Family childcare provides for children the comfort and experience of belonging to an extended family. I provide a home like setting; therefore, do not follow a strict routine. My approach to childcare is child centered and child directed. Children are offered choices whenever possible.

ABOUT ME AND MY FAMILY: My husband, Jason, and I have been married for 9+ years and have four children. Ada Grace and Ethan are 5 years old; Emi and Anya will be 1 in 2012. I have been caring for children since my young teen years. First as a babysitter and then as a church nursery worker. When I was a Freshman in high school, I directed my first of 5 children’s theaters at the local Opera House which put 40 children between the 1st & 8th grade in my care for 2 ½ hours 5 days a week. As a senior in high school I worked with the youth in my church and did this through college as well. After Jason and I were married I started doing childcare out of our home and did so until we moved to Spearfish. Shortly after moving here our daughter was born and so I decided to take a break, three months later our son came into our lives. Pumpkin Patch Daycare opened on October 28th, 2008.

Capacity: We work hard to not schedule more than 12 children at the same time, but with schedule changes it does happen occasionally. We do have two families with 4 total children that have chosen Pumpkin Patch DC as their back up to be used when the regular provider is closed. I will inform parents of this when I know in advance.

Hours of Operation: Pumpkin Patch DC is open from 7:00 AM until 5:30 PM Monday through Friday. Hours of care will be contracted from child to child. No childcare will be provided on Saturday or Sunday or on the following holidays:

New Year’s Eve & New Year’s Day, Good Friday, Memorial Day*, Independence Day (4th of July)*, Labor Day*, Thanksgiving & the day after, Christmas Eve, Christmas Day & the day after Christmas.

*Memorial Day, Independence Day, & Labor Day are paid holidays for Pumpkin Patch DC if that fall on a contracted day for your child.

-If a listed holiday happens to fall on Saturday Pumpkin Patch DC will be closed the Friday before and if the holiday fall on a Sunday we will be closed that Monday. In addition, Pumpkin Patch DC may close for 1 week (5 days) of paid vacation per year and 10 personal days (no charge) per year. Notifications of AT LEAST 2 weeks will be given prior to any closed days, with the exception of emergencies or illness. Please have a back up provider for these occasions. Pumpkin Patch DC is not responsible for finding alternate care for your child.

-Maternity leave. This is new to the 2012 contract, but needs to be included. Should we be blessed with another successful pregnancy my maternity leave will be 2 weeks from the time I come home from the hospital, three weeks if I have to have a C-section.

Payment Procedures:

Rates Per Child:

Birth ~ 11 months

Part Time: $2.75/hr Full Time: $2.25/hr

12 months ~ 23 Months

Part Time: $3.00/hr Full Time: $2.50/hr

24 Months & Up

Part Time: $3.25/hr Full Time: $2.75/hr

Before School: $3.50 a day After School: $3.00/hr

Drop Ins & After Hours (late pick ups): $4.00/hr with a minimum of $20.00 a day.

Fees: *Fees are put in place for a reason and no fee will be waived or overlooked.

Enrollment Fee: A fee equal to the amount of one week of childcare is due upon enrollment. This is due on or before the first day of care. The enrollment fee is put toward buying of new toys or general needs of Pumpkin Patch DC.

Deposit: The deposit is also equal to the amount of one week of childcare and is to be applied to the first week of the sixth month of childcare, after 6 months of reputable payment for care. This is nonrefundable before the 6 month time frame. THIS IS DUE THE FIRST WEEK OF CARE.

No Show Fee: $20.00 assessed if child is not brought as arranged without notice in addition to contracted rate.

Late Payment Fee: $10.00 per day, per child that payment is not received.

Returned Check Fee: $35.00 and additional costs incurred, along with my late fee if a check is returned to provider. There after payments will need to be in cash.

No Payment: You will be liable for cost fees, late fees, and any cost for loss of wages if there is a small claims case.

Snow Days: If the Spearfish school is closed, Pumpkin Patch DC will also be closed and there will be no charge for that day. Information about snow days will be sent out by text, on FaceBook page, and on the blog.

Definitions:

Full Time: Childcare contracted on a set scheduled time slot equaling 30+ hours per week. *If regularly scheduled full time child falls below the 30 hours per week, the part time rate will be applied to that week.

Part Time: Childcare contracted on a set schedule time slot of less than 30 hours per week. PT childcare occupies a FT position, should a potential client need a full time position, termination notice may be given to a PT child with the option of paying the minimum 30 hours per week at the FT rate to preserve the child’s slot. Daycare can only be guaranteed to children that attend full time, or part time children that pay for a full time slot.

Open Door: You are invited and welcome to visit Pumpkin Patch DC anytime your children are present. You are asked to avoid visiting during rest time (12:30-2:30 PM) as much as possible. Please knock first, but if no answer feel free to walk in, though due to a stranger walking in unannounced this summer we now lock the doors most of the time. Parents are also free to call Pumpkin Patch DC at any time. If I do not answer the phone, please leave a message and I will call you as soon as we are finished with the current activity.

Matters of Money: All payments are due by 5:30 PM on Friday for the following week. After 5:30 PM, the late fee will be assessed. If payment is not made within 3 days at drop off, your child will not be accepted into care until payment, including all late fees. If a period of 1 week passes without payment received, the contract will be terminated, the position filled, and the collection process begun. You will be responsible for any costs related to collection of the childcare fee. These costs will include late fees, days of lost wages, cost fees and my childcare fees. Cash or check is accepted and a receipt will be given with all payments. A year-end statement of all childcare costs will be provided within the first month of the New Year. A fee of $35.00 plus any additional costs I incur, along with my late fee will be charged to you for a returned check. All future payments will then be required to be made by cash. Childcare fees are due regardless of whether or not your child attends. You are paying for a position, as well as a service. No refunds are given for late arrivals or early departures. All childcare services will be contracted.

The contract is a legal document obligating me to provide a service for you and obligating you to pay me for that service. There are other requirements in the contract. I urge you to thoroughly read the contract/handbook and realize that it is legal and you will be held liable for each item of the contract. By signing it, you are accepting it and all its terms. An enrollment fee equal to one week of childcare service will be payable upon enrollment in Pumpkin Patch DC. A deposit fee equal to one week of childcare services is also due in your first week of services. This deposit will be applied to the first week of the sixth month of childcare, after the first six months of reputable payments for services. This fee is nonrefundable before the six month time. Payment of half the weekly rate will be charged for any extended leave due to illness or maternity leave, etc to hold the position. A position at Pumpkin Patch DC will be considered open until the enrollment, deposit, and first weeks’ fees are received. If care is to start more than 2 weeks in the future, a fee in the amount of 50% of the regular rate must then be paid weekly or the position will not be held open. This fee is non refundable and may only be used for 1 month.

Daily Doing:

Drop Off/Pick UP: I assume responsibility for your child only while he/she is on my property. No child will be allowed to leave with anyone except the parent, unless indicated on the alternate pick up list, without written permission from the parent. Telephone permission will not do! Anyone unfamiliar to me will be required to show proof of identification. Please make sure the alternate person is aware of the requirements. It is normal for your child to cry on arrival, especially for the first few weeks. Please make your good-bye brief and tell your child exactly when you will be returning. The crying usually stops within minutes of your departure. You are welcome to listen outside the door. Never leave without telling your child good-bye!!! Please be in control of your child during drop off and pick up times. This is a time of testing when two different authority figures are present (parent and provider) and this situation will be tested at one time or another to see if the rules still apply. I will remind your child if inappropriate behaviors are being displayed. But ultimately the parents are responsible for raising your child. Children of all ages adjust to transitions from one activity to another differently. Most do not like to be too rushed and most do not like to wait too long once they are ready to depart. If the person picking up the child appears to be under the influence of alcohol or drugs, another authorized person will be called to pick up both the child and the adult.

Court Order: If there is a court order keeping one parent or guardian away from the child, I must have a written note from the custodial parents or guardian in my file to that effect or a copy of the order. Otherwise, I cannot prevent the non-custodial parents from picking up the child.

Sick/Vacation Days: In the event that your child is ill and needs to miss a day, call/text/FaceBook/email at least 1 hour before your arrival time and no charge will be incurred. If NO notice is given you will be charged the No Show Fee in addition to the normal daily rate. Parent agrees to provide 2 weeks notice prior to any vacation time. Each child received one week (5 days) of vacation at no charge a year, one week (5 days) of ½ of the cost of care, and after those 2 weeks (10 days) you will be required to pay full price to hold your position.

Television: I allow TV viewing in the morning. Most of what will be on the TV are Signing Time DVDs or the Disney Chanel. Children are NEVER required to sit and watch, and TV is not offered in place of free play or learning activities. Examples of television shows allowed, but may not be limited to: Dora, Diego, Mickey Mouse Club, Handy Manny, Imagination Movers, etc. There is an occasional time that a movie would be allowed. Examples of movies we would watch include, but are not limited to: Finding Nemo, Milo & Ottis, Cinderella, Toy Story, Sleeping Beauty, etc.

Guidance (also known as discipline): No child will be hit, abused, or otherwise intimidated at Pumpkin Patch DC – even with parental permission. Children will be treated with courtesy, respect, and patience. Guidance will be according to age and understanding level. Younger children will be redirected to another activity. Older children will be given time outs depending on the severity of the offense. (Almost always 1 minute per year of age, never to be more than 15 minutes.) If a child becomes a persistent behavior problem, I will address it with you and we will try to resolve it together. AT NO TIME WILL A CHILD BE SUBJECTED TO PHYSICAL HARM OR SHAMING, FRIGHTENING OR HUMILIATING METHODS BE USED, OR ANY TYPE OF VERBAL ABUSE, THREATS, DEROGATORY REMARKS, OR DEPRIVED OF A MAIN MEAL.

Meals: I provide nutritionally balanced meals and snacks for your child. If a child arrives after a meal or snack has been served, he/she will wait until the next time to eat. Meals and snacks are served family style and children are encouraged to use this time to share their experiences with each other. Manners are taught, and practiced during this time as well. Please list on the medical report any food allergies your child may have. If your child needs a special diet, you must furnish these foods or extra fees may be applied to cover the cost of special foods.

Breakfast is at 8:00 AM, Lunch is served between 11:15 & 11:30 AM, and an afternoon snack is served around 3:15 PM.

Activities: Age appropriate activities are scheduled with flexibility allowed to respond to the needs of the individual child and day. I will offer times for outside play (seasonal), story time, free play, instruction, and naps. I will provide your child with tender loving care, understand, patience, and guidance in a happy family setting. Free play is an important part of a child’s early years. It is here that they learn social skills that will be needed the rest of their lives. Chores, such as picking up, putting the dishes in the dishwasher, laundry will likely be a part of the day.

An EXAMPLE of a day at Pumpkin Patch DC:

8:00 Breakfast & clean up. Potty time.

8:15 Free Play

9:45 Clean Up. Potty Time.

10:00 Craft, outside, or other structured time

11:15 Lunch & Clean Up. Potty Time.

12:00 Story Time

12:15 Rest Time

3:30 Snack & Potty Time

4:00 Playtime, clean up, & get ready to go home.

House Rules: 1) No hitting, biting, pinching, throwing, pushing, hair pulling, or otherwise harming ourselves or others. 2) No intentionally breaking anything. 3) No running, jumping, wrestling, climbing, etc. in the house or on the furniture. 4) No leaving the house or yard without permission (no one is allowed outside without adult supervision, even when parents are here.) 5) No picking up babies or toddlers. 6) No name-calling, yelling, foul language, or teasing ~ everyone deserves to be treated with respect. 7) All food and drink will remain in the dining room/kitchen area, those with sippie cups are allowed water in play area. 8) No lying!

Dress Code: Please dress your child appropriately. Weather permitting, we will spend time outdoors. You also need to supply a complete change of clothing in case of an accident; I do not supply clothing, if the child has no spare clothing, the parents will be called to bring him/her home.

Water Play: I have a sprinkler & small wading pool for summer water play. You will need to sign permission slips in the spring of each year before our child is allowed to use them. A swimsuit & swim diaper (if applicable) are requested to be left here.

Toys: Please do NOT send any toys from home with your child, they tend to be used to cause problems with the other children that do not have ‘special toys.’ THIS RULE WILL BE STRICTLY ENFORCED, TOYS BROUGHT IN TO DAYCARE WILL BE SENT HOME WITH PARENTS. If your child needs a special stuffed animal or blanket for sleeping, it will be allowed, but it will remain put away until Rest Time. Pumpkin Patch DC assumes NO responsibility for lost, stolen, or broken toys from home. Should the child deliberately destroy my toys or other property through misuse or willfulness, the parent will be required to replace it.

Rest Period: All children will have a rest period. No child is forced to sleep, however they must partake in quiet time. Older children can bring books or a quiet activity from home that they can do on their rest mat/bed until Rest Time is over; these books/activites should be brought in a bag or backpack so they can be stored until rest time. Please try not to schedule pickups or visits during this time (12:30 – 2:30) to lessen disturbance to the resting children. All children will rest on their mats or in a crib/pack n play.

Potty Training: I will assist you in potty training your child with the understanding that it will only be successful if we work together. You will be required to provide pull-ups…no cloth diapers or training pants will be allowed. Under no circumstances will your child be allowed to train in regular underwear for sanitary reasons! They are not allowed in panties/underwear until they are able to tell me they need to go potty and keep their pull-up dry for a week. Send your child ONLY in easy on/easy off clothing until they are able to completely dress and undress themselves. I require at least 3 complete changes of clothing during potty training. I do not launder soiled items and will send them home in a plastic bag. Please replace any clothing sent home on the next day. Please know that while they may be doing well at home, at daycare there are several distractions that may hinder how well they do here. Pull-ups are required until they can tell me they need to go potty on their own! Further, if within 2-3 weeks your child shows no signs of progress, I reserve the right to put your child back in diapers and tray again at a later date. At the Patch we use ‘tinkle & stinky’ in reference to potty.

Transportation: At times it may be necessary for me to transport your child by car. A permission form is provided upon enrollment. All traffic and safety laws will be followed. No child will ever be left unattended in a vehicle. Also, because this business is run out of my home, it may be necessary to run occasional errands with the children. Parents will be notified at drop off time or with a phone call. The only time we may leave without notice is in the case of an emergency, in which a note will be placed on the door leaving instructions where the children can be found. Unless it is an emergency, you will always be notified prior to any outing from Pumpkin Patch DC by vehicle and reserve the right to refuse. If I do not have your permission to transport your child, you are expected to pick up your child immediately and make alternate childcare arrangements for that day. There will be times that we take walks to the park or just around, those days there will be a note on the door stating what time we left and what we are up to.

Holidays/Birthday: We honor major holidays. If you would like to bring a special treat (no homemade treats without recipe included) for the children, please bring enough for everyone. You are more than welcome to participate in ANY activities we have planned.

House Cleaning: My house is not always clutter free, but it is sanitary. My main concern is to care for the children. I clean my house during Rest Time, if all are asleep, and during non-business hours. The children will clean up toys before meals and before going home. Since Pumpkin Patch DC is out of my home, there is a possibility that laundry, putting dishes in the dishwasher, and picking up will be a part of any given day.

Confidentiality: The information you supply to Pumpkin Patch DC will be kept confidential. I will at all times respect your privacy. Before any of the information is released to outside persons, the parents will sign a release form.

Changes to Policies: Changes may be made to these policies as needed with 2 weeks notice. The policies, contracts, consents, and forms will be reviewed and updated, if needed, yearly in January. Please give written notice of any changes that may occur, especially of name, address, phone number, or updated immunizations.

Emergencies:

Fire: There is one extinguisher located in the kitchen. If there is a fire that cannot be extinguished quickly, the children will be evacuated immediately before calling 911.

Tornado: In the event of a tornado warning, the children will gather in the master bedroom closet. We will remain there until the inclement weather has passed. If time allows we will load up and go to 218 Wyoming Ct. just a few blocks away at a friend’s house that has a basement!

Power Outage: There are flashlights located in the kitchen & bathroom. If the power remains out for some time, there will be non-perishables on hand. We also have a gas stove that can be lit with a match. If the weather is inclement and the house is getting too cold for the children, you will be called to pick up your child.

Enrollment Requirements:

Before enrolling your child in Pumpkin Patch DC there are several things you must do:

1. Read through and become familiar with the policies. You will be required to sign a form that indicates you have read, understand, and agree to ALL the policies as outlined.

2. An interview/acquaintance visit must be made. I will not care for children unless they have had a visit to Pumpkin Patch Daycare to become familiar with me and the service provided.

3. All appropriate forms must be filled out, signed, and on file PRIOR to admission. All necessary form/consents will be given to you in your admission package.

4. All required supplies must be brought before your child’s first day. If you do not bring the required supplies I will purchase them for you and you will be responsible for reimbursing me the full cost.

5. Deposit, Enrollment Fee, & Payment for first week of care must be taken care of before child starts at Pumpkin Patch DC.

Termination of Care: Care can only be terminated with 2 weeks notice by the parent. I reserve the right to immediately end care for non-payment, failure to respect me, my home, my neighborhood, behavior of the child which is harmful to the physical or emotional well being of the other children or himself, or failure to abide by my policies. If you terminate care without giving appropriate notice, you will be responsible for payment of the final 2 weeks of care whether or not your child attends. Please be advised that you will be charged the No Show Fee in addition to your scheduled daily rate until you notify me that your child will not be returning. Vacation time/pay cannot be used for your two week notice. *Provider has the right to terminate a contract without notice for any reason.

Child Abuse/Neglect: I am required by law to report any suspected signs of child abuse and/or neglect.

Supplies: All supplies must be labeled with your child’s name. You will need to provide the following things to be left here:

1. One complete change of clothing (3 if we are potty training.) This includes shirt, pants, socks, and underwear. Careful attention must be made to maintain current sizes left here.

2. Any over the counter medications that you may wish to be used. This must have this child’s name on it. Remember I will always ask your permission before administering.

3. Diapers or Pull-ups, 1 full package to be stored in your child’s cubby and I will notify you when the supply is low.

4. Any cream, powder, etc. that you wish me to use.

5. Bottle or Sippie cup that child is familiar with, along with formula/breast milk if necessary.

*These items are all necessary for me to care for your child, if you choose not to supply me with the required items, I will purchase them for you and you will be responsible for the cost.

*Pumpkin Patch DC will supply Members Mark baby wipes, if your child has special allergies you will have to provide your own.

Health Matter:

Illness: Under no circumstances is a sick child to attend Pumpkin Patch DC. The children should be allowed to recover fully from an illness in the comfort of their own home. The other children in care are exposed to any illness your child may bring into the home. If you are unable to remain home with your child, it is your responsibility to make substitute childcare arrangements. Obviously, it is not possible to prevent the spread of all illness. However, minimizing exposure and providing good hygienic practices in the daycare home are means by which we can limit the problem and the resulting inconvenience. Accordingly, for the benefit of all involved, the following policies will be strictly enforced:

Children who have exhibited ANY symptoms of infectious illness within the proceeding 24-hour period are likely to be contagious and should remain at home. Examples of associated symptoms include, but are not limited to: fever of 100F or more, nausea or vomiting, diarrhea, sore throat, loss of voice, hacking or continuous coughing, yellow or green runny nose, draining eyes or ears, rash, or head lice. I reserve the right to determine whether a child should remain in the home where illness is a consideration. Parents of children who become ill during the day will promptly be notified and are expected to arrange immediate pick up for their child. The ill child will be isolated from the other daycare children to minimize exposure. If the parents cannot be reached, the person designated as the emergency contact will be notified. Pumpkin Patch DC reserves the right to refuse care to a child due to suspected illness.

Medications: No child will be given medication, prescription or over the counter, unless the parent gives written permission. Prescription medication shall be in the original container and have that child’s name on it with a current date and directions for administering. I have permission to administer medication forms to be filled out each time your child will need medicine to be administered. Written permission is required in order to use diapering products, sunscreen lotion, and insect repellents. ***A child is to remain home for 24 hours after being put on a medication they have not had before, this includes immunizations/flu shots they have not had before.

Medical Emergencies: Although supervision is constantly given, I cannot be at each child’s side at all times to prevent falls, tripping bumps, or blows from other children, etc. If the child is injured in a non life-threatening way, I will assess the situation and provide home first aide. If the injury is more serious, 911 will be called and an ambulance will transport your child to the hospital. In case of a medical emergency I will attempt to contact you immediately, if I am unable to reach you I will call your emergency contacts. All costs associated with injuries to the child will be the responsibility of the parents. You or your family’s insurance is/are responsible for the cost of medical help of treatment due to accidents or illness while at Pumpkin Patch DC.

Non-Discrimination: As a childcare provider, I shall not discriminate in relation to admissions on the basis of race, creed, color, national origin, religion, or gender.





REMINDER: These policies/guidelines are set for the best interest of the child. They will only serve their purpose if you (the Parent) stand behind them. At no time will it be tolerated that these policies are not carried out.


Ashley ~ Pumpkin Patch Daycare

2012 Contracts due back on or before January 13th 2012

Pumpkin Patch Daycare


The Home Front Contract

This contract is an agreement between:

___________________________ & Ashley Hartung (Pumpkin Patch Daycare)

To provide care for:

______________________________________________________________

This contract will be in effect from __________ to January 13th 2012.

There will be a 2 calendar week trial period in which either party may end this agreement, for any reason. Any fees paid will not be refunded should this occur. This does not apply to yearly renewal contracts.

This contract is a first time contract/yearly renewal – circle one.

Rates and rules for payment are outlined in the Pumpkin Patch Daycare Handbook; Please do not sign this contract until you have read all rules regarding rates and late fees, etc.



It is agreed that schedules will be made by Friday for the following week. Payments are due on Fridays by 5:30 PM for the following week, according to this schedule.



This contract is simple, as all rules are outlined in my parent handbook and agreed upon and followed as part of this contract:

I have received a copy of the Pumpkin Patch Daycare Handbook and agree: __________ (initials)

Permanently enrolled families will receive their own copy or you may also view a copy at Pumpkin Patch Daycare’s blog.

Parents Name:_____________________________________________________________

Parents Signature:__________________________________________________________

Date:_____________________________________________________________________

Provider Name: Ashley Hartung, Pumpkin Patch Daycare

Provider Signature:_________________________________________________________



Registration Form

Child(ren)’s Full Name(s): _____________________________________________________________________________________

Birthdate(S):__________________________________ Nickname(s):____________________________

Home Address:________________________________________________________________________

Home Phone:__________________________________________________________________________

Email Address (for pictures and updates):___________________________________________________

Mothers Name:_____________________________ Occupation:_____________________________

Place of Employment:________________________ Length of Employment:____________________

Work Phone:_______________________________ Cell Phone:__________________Text?_______

Fathers Name:______________________________ Occupation:_____________________________

Place of Employment:________________________ Length of Employment:____________________

Work Phone:_______________________________ Cell Phone:___________________Text?______

Parent/Guardian with legal custody:_______________________________________________________

Parents are: Married/Divorced/Separated/Single

*If parents are separated or divorced, please indicate whether the other parents has permission to have contact with the child at Pumpkin Patch Daycare and whether or not he/she is allowed to pick up the child. If there is a no contact order for the non custodial parent I will need to have a copy of the paper work.

Contact: Yes/No/Not Applicable Pick Up: Yes/No/Not Applicable

Emergency Contact Person in addition to parents. (They must be within a 20 mile radius of Spearfish.) Name/Relationship _______________________________________ Phone ________________________ Name/Relationship _______________________________________ Phone ________________________ Name/Relationship _______________________________________ Phone ________________________

Other than you, who has permission to pick up your child? Any person not listed will not be allowed access to your child. Anyone other than the parents will be required to show photo identification at pick up. Anyone (including parents) should have proper child restraints for transportation. Name/Relationship _______________________________________ Phone ________________________ Name/Relationship _______________________________________ Phone ________________________ Name/Relationship _______________________________________ Phone ________________________ Name/Relationship _______________________________________ Phone ________________________



About Your Child

1. What foods does your child(ren) especially like?___________________________________________

2. Especially dislike?________________________________________________________________

3. Child’s usual dining habits: Highchair/Table/Uses Utensils/Bottle/Sippie Cup/Regular Cup

4. Does your child have a small or large appetite?________________________________________

5. Breakfast is served at 8:00 am, will your child eat breakfast before coming to Pumpkin Patch Daycare? Yes/No

6. If your child is drinking formula, do they prefer it: Warm/Room Temp/Cool

7. Favorite toys, games, activities?____________________________________________________

8. Is your child potty trained?________________________________________________________

9. We use ‘potty’, ‘tinkle’, & ‘stinky’ at Pumpkin Patch Daycare, it would be helpful if while training your child you used the same terms.

10. Do you wish me to help them with potty training while here? Yes/No

11. How would you describe your child’s personality?______________________________________

12. How does your child express anger or frustration?______________________________________

13. Does your child have any special fears?_______________________________________________

14. When your child is upset, what helps to comfort him/her?_______________________________

15. How do you DISCIPLINE your child?__________________________________________________

16. Has your child been taking a morning nap? Yes/No If so, how long?____________________

Afternoon nap? Yes/No If so, how long?____________________

17. Special toy or blanket for nap?_____________________________________________________

18. What is your child’s disposition when waking up?______________________________________

19. Special family situations? (such as custody specifications, problems arising for situations, etc?)___________________________________________________________________________________________

20. Anticipated adjustment problems?__________________________________________________

21. Any disorders/developmental (slow or advanced) diagnosed or suspected? ______________________________________________________________________________

22. Previous daycare child has attended?________________________________________________

Dates? From:__________ To:__________

Phone:_____________________________

Contact: Yes/No

23. Why was care terminated?________________________________________________________

24. Any problems at previous daycares?_________________________________________________

25. Expectations of Pumpkin Patch Daycare:___________________________________________________

26. Other comments: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



Health History

1. Last Physical Exam:_______________________________________________________________

2. Does your child need regular medications for a health problem? Yes/No

If yes; what, when, and how is it given:________________________________________

*Please sign the permission forms, authorizing Ashley Hartung (Pumpkin Patch Daycare) to administer the medication needed.

Illnesses: (please circle if your child has [or has had] any of those listed)

Constipation Convulsions

Diarrhea Fainting Spells

Frequent Colds Frequent Ear Infections

Frequent Sore Throats Lice

Ringworm Skin Rash

Soiling/Smearing Worms

Urinary Problem Asthma

Bronchitis Chicken Pox

Diabetes Heart Disease

Hepatitis Measles

Mumps German Measles

Polio Scarlet Fever

Tuberculosis Whooping Cough

Sleep Apnea Night Terrors

Sleep Walks



3. Other illnesses? (besides above):____________________________________________________

4. Has your child been hospitalized: (explain) ___________________________________________

5. Has your child had injuries with fractures or loss of consciousness? (explain) ________________

6. Last Vision test:_______________ OK?_______________

Last hearing test:_______________ OK?_______________

Last dentist visit:_______________ OK? _______________

7. Any other members of your family with serious illness recently?__________________________

8. Any other members of your family with history of:

Asthma: Yes/No Diabetes: Yes/No Epilepsy: Yes/No

9. Any allergies? Yes/No List:_______________________________________________________

Special instructions in the event of an allergic reaction:_____________________________________

10. Does your child have any mental or physical disabilities? Yes/No _________________________



Parents Name: _____________________________________________

_____________________________________________

Parents Signature: _______________________________________

_______________________________________

Date: ______________________________________________________

Provider: Ashley Hartung, Pumpkin Patch Daycare

Provider Signature: __________________________________________

Date: ______________________________________________________



































Permissions

MEDICINE (Over the Counter)

Ashley Hartung (Pumpkin Patch Daycare) has my permission to administer over the counter type medication (Tylenol, Dimetapp, Diaper Rash Ointment, Sun Block, etc.) to my minor child.

Child’s Name:__________________________________________________________________________

Parent/Guardian Signature:______________________________________________________________

Date:_________________________________________________________________________________

MEDICINE (Prescription)

Ashley Hartung (Pumpkin Patch Daycare) has my permission to administer Prescription medication to my minor child. Prescription should be in the original container with the child’s name, date prescribed, and dosage on the label.

Child’s Name:__________________________________________________________________________

Prescription:___________________________________________________________________________

When & How to take prescription:_________________________________________________________



Parent/Guardian Signature:______________________________________________________________

Date:________________________________________________________________________________

Trips

Ashley Hartung (Pumpkin Patch Daycare) has my permission to transport my minor child in her private vehicle. Trips will not be out of the Spearfish area without further permissions, and each child will be in the appropriate care restraint. Child’s Name:________________________________________________

Parent/Guardian Signature:______________________________________________________________

Date:_________________________________________________________________________________

General

Ashley Hartung (Pumpkin Patch Daycare) has my permission to:

Take my child on a walk? Yes/No Take my child swimming: Yes/No

Take Photos of my child: Yes/No Put photos on Patch’s blog or FaceBook: Yes/No

Give an occasional candy treat? Yes/No Assist child with potty training? Yes/No/Not App.

Child’s Name:_________________________________________________________________________

Parent/Guardian Signature:______________________________________________________________

Date:________________________________________________________________________________



Permissions



Medical Care

Ashley Hartung (Pumpkin Patch Daycare) has my permission to seek and obtain emergency medical, dental, or surgical treatment as prescribed by a treating physician for my minor child. I give my permission for my child to be transported by care or ambulance to and emergency center for treatment.

Full Name of Minor:_____________________________________________________________________

Birth Date:____________________________________________________________________________

Allergies to Med.:______________________________________________________________________

Special Health Problems:_________________________________________________________________

Regular Medications:____________________________________________________________________

Blood Type:___________________________________________________________________________

Name of Doctor:_______________________________________________________________________

Name of Insurance Co.:__________________________________________________________________

Member/Policy Number:_________________________________________________________________

On record at Spearfish regional Medical Center: Yes/No

Name of Policy Holder:__________________________________________________________________

Pumpkin Patch Daycare shall not be responsible for providing or paying for the child’s health care. I agree that neither I or my child will bring any claims of any kind against Ashley Hartung and Pumpkin Patch Daycare as a result of any injuries, expenses or damages that I or my child may suffer in any way related to the use of our facilities, toys, other children, whether such claims are known or unknown or arise in the future.

Parent/Guardian Signature:______________________________________________________________

Date:_________________________________________________________________________________




Ashley ~ Pumpkin Patch Daycare