ELC Enrollment Form, 2021.2022

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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.

Email *

Name of person completing this form, and relationship to child(ren): *

Child 1 First Name *

Child 1 Last Name *

Child 1 Date of Birth *

YYYY

Does Child 1 have any known health conditions/allergies? If yes, please explain *

Child 2 First Name (if none, type N/A)

Child 2 Last Name (if none, type N/A)

Child 2 Date of Birth (if none, leave blank)

YYYY

Does Child 2 have any known health conditions/allergies? If yes, please explain

Child 3 First Name (if none, type N/A)

Child 3 Last Name (if none, type N/A)

Child 3 Date of Birth (if none, leave blank)

YYYY

Does Child 3 have any known health conditions/allergies? If yes, please explain

Requested Start Date (must be at least two weeks from date of of filling out this form) *

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. *

Parent 1 Name *

Parent 1 Email *

Parent 1 Phone Number *

Parent 2 Name *

Parent 2 Email *

Parent 2 Phone Number *

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. *

Will your child(ren) need to have any medications on site at the ELC? If yes, please explain. *

Is your child(ren) currently taking medications? *

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. *

Does your child have a 504 plan? *

Yes

Does your child have an IEP or an IFSP? *

Yes

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. *

Type your signature along with today's date below to confirm your application for enrollment for Trinity's ELC. *

A copy of your responses will be emailed to the address you provided.

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