Downtown - Enrollment Form - First Presbyterian Day School (Page 2 of 4) in pdf

First Presbyterian Day School Downtown

Extended Day Program

682 Mulberry Street

Macon, Georgia 31201

(478) 254-2906

Parental Agreement

1. The Extended Day Program at FPDS Downtown agrees to provide child care for_____________________________ on

Child’s Name

F, from _______ to _________ during _____________________ to _________________________.

(Circle all that apply)

Time

Month

2. Before any medication is dispensed to my child, I will provide a written authorization using the center’s medication form,

which includes: date, name of child, name of medication, prescription number (if any), dosage, date and specific time of day

medication is to be given. Medication will be in the original container with my child’s name marked on it.

3. I acknowledge it is my responsibility to provide transportation to and from the center. My child will not be allowed to

enter or leave the facility without being escorted by the parent (s), person authorized by the parent(s), or facility personnel.

4. I acknowledge it is my responsibility to keep my child’s records current to reflect any significant changes as they occur

(phone numbers, work location, emergency contacts, child’s physician, child’s health, immunization records, etc.)

5. The facility agrees to keep me informed of any incidents, including illnesses, injuries, adverse reactions to medications,

etc., which include my child.

6. The Extended Day Program at FPDS Downtown agrees to obtain written authorization from me before my child

participates in field trips, special activities away from the facility, and water-related activities occurring in water that is more

than two (2) feet deep.

7. I agree to provide a nutritious lunch labeled with my child’s name. The lunch must include 1 serving of 1 1/2 to 2 oz.

protein, 1 serving of ½ to ¾ cup fruit, 1 serving of ½ to ¾ cup vegetable, and ½ slice of bread. I also agree to pay the

supplement fee to the Extended Day Program if the lunch does not satisfactorily meet the USDA requirements.

8. Unless I indicate otherwise by a written note, I give permission for my child to participate in any walking field trip or

activity. I understand that a notice of all walking field trips will be posted at the time of the event. The facility does do off

campus field trips and if no parent can drive we will use our personal vehicles.

9. The Extended Day Program at FPDS Downtown encourages parent’s participation in all school and center activities.

10. The facility agrees to advise parents of their child’s progress, issues related to the child’s care and individual practices

concerning the child’s special needs.

11. I acknowledge that the Extended Day Program and Preschool at FPDS Downtown is exempt from state licensing based

on our accreditations, SAIS, AdvancED and CESA. We comply with all applicable statutes and governmental regulations

related to preschool/afterschool programs.

12. I have received a copy of and agree to abide by the current policies and procedures for the Extended Day Program at

FPDS Downtown.

Signed _______________________________________________________ Date __________________________

Parent/Guardian

Signed _______________________________________________________ Date __________________________

Administrator/Director

Downtown - Enrollment Form - First Presbyterian Day School Page 2