SKC 2020 Written Information Packet Documentation
Michigan Department of Licensing and Regulatory Affairs
Bureau of Community and Health Systems
Center Name: Lakeland Child Care OR Mill Creek Child Care
Please read the entire document below, sign, list children and submit.
ONE FORM PER FAMILY (BCAL-4340 (10-16) MS Word)
A written information packet (“Participant Handbook 2019-2020”) has been provided at the time of enrollment. The packet includes all of the following information: *Criteria for admission and withdrawal *Schedule of operation, denoting hours, days, and holidays during which the center is open and services provided *Fee policy *Discipline policy *Food service policy *Program philosophy *Typical daily routine *Parent notification plan for accidents, injuries, incidents, illnesses *Exclusion policy for child illnesses *Notice of the availability of the center’s licensing notebook *The licensing notebook contains all the licensing inspection and special investigation reports and related corrective action plans since May 28, 2010.The licensing notebook is available to parents during regular business hours.Licensing inspection and special investigation reports from at least the past two years are available on the child care licensing website at
. MEDIA RELEASE: I understand that: 1. I give the programs (“Wee” Are ER Preschool, Kids’ Club and Summer Kids’ Club) permission to videotape or photograph my children for school purposes. Newspaper photographers or T.V. reporters may ask to take pictures of student activities. 2. I give permission for my child to appear and to be named in newspaper photographs. My children may be videotaped or photographed for educational purposes. If a child’s picture is used on our district website
, no names will be included. Unless I revoke my permission in writing, by CIRCLING the number #1 or #2, All Programs have permission for the above activities (#1 & #2) for the entire year 2019-2020. When field trips require transportation, children will be transported by an Elk Rapids Schools’ school bus. Any transportation not considered routine, such as field trips, require signed permission slip prior to departing for field trip. Program Director will provide written permission slip listing single or multiple field trips for Parent to give permission including field trip date, time, location and cost (if applicable). PRESCHOOL: Routine Transportation: If applicable, I allow my Preschool child to be transported to/from school by Elk Rapids Schools’ school bus transportation. “Routine transportation” means regularly scheduled travel on the same day of the week, at the same time, to same destination.Other: Parent/Guardian agrees by signature below to follow the stated “ADMISSION, DEPOSIT, TUITION FEES & SCHEDULES” For All Programs and has read, understands and agrees to the “TUITION PAYMENT & STATEMENTS” For All Programs AND 7 Day “Extended Time Off” Notice as outlined in the “Participant Handbook 2019-2020”. NOTE: A single BCAL-4340 “Written Information Packet Documentation”one form may be used for all children in the same family.LARA is an equal opportunity employer/program. BCAL-4340 (10-16) MS Word ---- List any exception below:
List any exception below
I have read and understand entire document above
Parent/Guardian Signature: By my signature below, I agree to read and follow all program handbook policies & certify receipt of the above items (Participant Handbook 2019-2020). ACTUAL SIGNATURE and DATE is required on form
For SKC 2020: List all children in the family this document applies for:
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