UPPERROOM Academy 2024 - 2025 Enrollment

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UPPERROOM Academy 2024 - 2025 Enrollment | 1350 Manufacturing St. Suite 111 Dallas, TX 75207
Childcare Operation: #1680468

Email *

My Child is a: *

New Student

Re-Enrolling

Child's: Last Name, First Name *

Birthday *

YYYY

Age as of 09-01-24 | Years and Months | Example 3.5 *

Sex *

Female

Male

Guardian 1 Name: *

Guardian 1 Phone Number: *

Guardian 1 Email: *

Guardian 2 Name: *

Guardian 2 Phone: *

Guardian 2 Email: *

Child Resident Address | Street, City, State, Zip Code: *

Has your child had an IEP ( Individualized Educational Plan)?

Please email the latest IEP to school admin

Yes

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List any concerns that your child may have, such as allergies, existing illness, previous serious illness, diagnosis, injuries and hospitalizations during the past 12 months, any medications prescribed for long-term continuous use, or outside services. Examples include but are not limited to: Sensory, cognitive, behavioral needs or any other information that would be helpful for caregivers to be aware of: *

My child has serious allergies that require an EPI-PEN: *

Yes

I would like to sign up my child for care for the following program: *

Media Release | Do you approve UPPERROOM Academy and UPPERROOM Dallas to photograph your child, take motion pictures of your child, and or electric sound recordings? *

YES, I do authorize photography and electronic reproductions of my child.

NO, I DO NOT authorize photography and electronic reproductions of my child.

Do you authorize UPPERROOM Academy Staff to apply Babyganics sunscreen and insect repellent to your child: *

Yes

I realize I am REQUIRED to download the app CLASSDOJO for teacher communication will do so: *

Agree

Disagree

I will add the UPPERROOM Academy google calendar to my account to stay up to date with school activities: *

Yes

I acknowledge I have received and read the UPPERROOM Academy Parent Handbook: *

Yes

Required

Gang Free Zone

Under the Texas Penal Code, any area within 1,000 feet of a child care center is a gang-free zone, where criminal offenses related to organized criminal activity are subject to harsher penalties

I have received the facilities operation policies, including those for: Discipline and Guidance | Suspension and Expulsion| Emergency Plans | Procedures for parents to discuss concerns with the Director | Procedures for parents to participate in the operational activities | Procedures for the release of childrenIllness and exclusion criteria | Procedures for dispensing medicationsImmunizations requirements for children | Meals and food services practicesEnrolled child(ren) will be served snack and lunch is provided by Parent/Guardian Procedures to visit the center without securing prior approval | Procedures for parents to contact Child Care Licensing (CCL) DFPS, Child Abuse Hotline, and CCL website. | Non Discrimination Statement *

Privacy Statement

HHSC values your privacy. For more information, read your privacy policy online at: https:hhs.texas.gov/policies-practices-privacy#security

All the Information above is correct and true to my knowledge: *

Yes

I understand the following forms will be due before my child may begin: *

Updated Immunizations

Health Statement (one per child upon entry)

Hearing and Vision Screening for: Over 4 years of age by September 1, Kindergarten, 1st Grade, 3rd Grade, First Time Entrants

Hard Copy of Affidavit of Exemption from Immunizations (if exempting immunizations)

F.A.R.E Allergy Plan signed by Pediatrician | If Child requires an Epi-Pen

Required

AGREEMENTS Your child's spot will be held when we receive your enrollment fee and enrollment application.The enrollment fee will be invoiced through Brightwheel or you may pay by check payable to the "UPPERROOM" with a memo: UPPERROOM Academy. Enrollment Fees are nonrefundable. Tuition is due on the 1st of the month through Brightwheel. A late fee of $25.00 will be charged after the 3rd of the month. If you do not pay tuition by the 15th of the month your child will not be able to attend school until the account is up-to-date. By submitting this form, you are signing your child up for the 2024 - 2025 school year. A 30-day notice is required if you choose to remove your child before the end of the school year. In the event that you are unable to give a 30-day notice, you will still be required to pay the next months tuition. If you have read and accept all the terms, please type name below as an electronic signature that legally binds this contract: *

Date: *

YYYY

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

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