ELC Enrollment Form, 2021.2022
Ready to join our family, or to continue your time with us? Please fill this form out for enrollment in the Trinity ELC. This form is for 6 weeks through 5 years and also for ages 5+ for summer care, drop in care, and before and after care.
* Required
Email address
*
Your email
Name of person completing this form, and relationship to child(ren):
*
Your answer
Child 1 First Name
*
Your answer
Child 1 Last Name
*
Your answer
Child 1 Date of Birth
*
MM
/
DD
/
YYYY
Does Child 1 have any known health conditions/allergies? If yes, please explain
*
Your answer
Child 2 First Name (if none, type N/A)
Your answer
Child 2 Last Name (if none, type N/A)
Your answer
Child 2 Date of Birth (if none, leave blank)
MM
/
DD
/
YYYY
Does Child 2 have any known health conditions/allergies? If yes, please explain
Your answer
Child 3 First Name (if none, type N/A)
Your answer
Child 3 Last Name (if none, type N/A)
Your answer
Child 3 Date of Birth (if none, leave blank)
MM
/
DD
/
YYYY
Does Child 3 have any known health conditions/allergies? If yes, please explain
Your answer
Requested Start Date (must be at least two weeks from date of of filling out this form)
*
MM
/
DD
/
YYYY
(For Infants through Junior Kindergarten ONLY) My child(ren) will be attending:
*
Full Time, Monday through Friday
Part Time, 3 days per week (must remain the same each week)
Part Time, 2 days per week (must remain the same each week)
N/A
A normal drop off time for my child(ren) will be:
*
6a-630a
630a-645a
645a-7a
7a-715a
715-730a
730a-745a
745a-8a
8a-815a
815a-830a
830-845a
after 845a
N/A, my child is in after care only for K-8th grade
I understand that drop off time for the ELC is from 6am to 915am. Please type your initials below to confirm.
*
Your answer
Parent 1 Name
*
Your answer
Parent 1 Email
*
Your answer
Parent 1 Phone Number
*
Your answer
Parent 2 Name
*
Your answer
Parent 2 Email
*
Your answer
Parent 2 Phone Number
*
Your answer
All forms can be found at
tlsonline.org/elc-parents
, and I understand that all of the following paperwork must be submitted prior to my child(ren)'s start date:
*
My Health Inventory and Immunizations (must be updated annually) along with Lead Certificate
My Emergency Contact Form (must be updated annually)
My Enrollment Agreement
My child’s birth certificate
My child’s All About Me Forms (must be updated annually)
Infant Toddler Needs Summary (for any child under 24 months, and must be updated every 30 days)
Required
My child(ren)'s brightwheel account(s) are up to date with the requested information below (if you're a new family, this account will be created once we've reviewed your enrollment application):
*
Parent/Guardian phone numbers, including work.
Parent/Guardian email
Parent Guardian first and last name
Child(ren)’s date of birth
Any allergies/medical conditions for the child(ren)
Child(ren)’s home address
Child(ren)’s contacts, including parents, approved pickups, & emergency contacts
Billing information
Required
I understand that my registration fee is due at time of enrollment and prior to my child(ren)'s start date, and I will pay through brightwheel billing. Type your initials below to confirm.
*
Your answer
Will your child(ren) need to have any medications on site at the ELC? If yes, please explain.
*
Your answer
Is your child(ren) currently taking medications?
*
Your answer
I understand that if my child(ren) need to have medication on site that I am required to provide the following- the medication, labeled with a pharmacy label including all information; the appropriate medication administration form completed with accurate instructions from the provider; medication and forms that are up to date and not expired. Type your initials below to confirm.
*
Your answer
Does your child have a 504 plan?
*
Yes
No
Does your child have an IEP or an IFSP?
*
Yes
No
If you are enrolling in before and after care (K-8 ONLY), please answer the following
I am in need of BEFORE CARE ONLY
I am in need of AFTER CARE ONLY
I am in need of both BEFORE AND AFTER CARE
I am in need of DROP IN CARE
I am in need of SUMMER CARE
Clear selection
I understand that at anytime, the policies and procedures may change with notice from the director based upon updated guidelines from the Office of Childcare and/or the CDC and local health department. I also understand that I am responsible for following all guidelines. Type your initials below to confirm.
*
Your answer
Type your signature along with today's date below to confirm your application for enrollment for Trinity's ELC.
*
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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