Indicates required field
Child's Date of Birth
Step 1: Provider's History
- Licensed for a capacity of _____ children. Currently have _____ openings. Waiting list ______
Private school teacher for 2 years/Home schooled - 4 year/Home child care provider since 2001. My why?
- CPR trained _____________ expiration date ______________(+) extra help
- Graduate of the Smart Start San Jose School Readiness Program
- 35 (+) units in Early Childhood Education: San Jose City College/Mission College/West Valley College
- Educational Consultant with Discovery Toys/Innovative & Creative ways to teach is my hobby
- Ages & Stages Questionnaires that will help your child grow mentally, physically, socially and emotionally
- ABC Troopers Honor’s Club/Support Group for ADD/ADHD children & teens.
- My program philosophy is-Embrace DLS, Acknowledge MI and Empower Children to think outside of the Box.
- Goal is to open a charter school for at risk children with ADD or ADHD Entrepreneurial Development Skills
- MBC Networking Dream Coach helping people work from home since 2006
- Married since 2003 and I have two boys 13 years apart, a dog named Moo and a bunny farm
Do you agree to all the terms of Step 1?
Step 2: Interviewing Process
- Hygiene washes hands upon arrival, at meal time, potty time, toys and animal care
- Safety measures in place-Fire Extinguisher ___ First Aid Kit ___ Safety gates____ Safety Plugs ___
- Disaster plan Hank Lopez Community Center, Reid-Hillview Airport
- Daily Schedule: School Year ____ Summer Drills ____ Summer Enrichment Programs ____
- Honor Roll Incentive Program/Homework Club/Tutoring M-F 4 to 6 pm-Fun Friday/Store
- ABC Trooper’s Honors Club/100 Skills earned that can helps improve lives and communities (2)
- Field Trip, Walks Around the neighborhood, Pick-up & Drop-off’s to schools
- Meals provided/Food Programs based on healthy nutritional meals (Yes/No) – Start Date: _________________
- Daily Communication Log: What Was My Week Like? Behavior, Homework Helpful (5)
- Age-Appropriate Discipline Techniques: What is Discipline? Dr. Phil and The Total Transformation/Calm Parents
- Disciplinary consequences take away stickers/teach limits & self-control/roll play correct behaviors
- Forms: Parental Involvement/Learning About You/Parent’s Homework/Parent’s Discipline Rules
- Confidentiality Form to discuss your child’s issues with others for advice/resources
- Fundraises for field trips and events
- Permission to post your child’s photos on FB of field trips, curriculum data, parent text or advertisement Yes ___ No ___
Do you agree to all the terms of Step 2?
Step 3: \If interested, give contact forms Date: _______ Registration Fees agreed to Pay: _______
- Registration Fee Sheet: Non-Refundable/Transportation Fees/Bounced Checks/Credit Days for 5+ months
- 10 Legal Paid Holidays/Vacation Agreements $1 per day + weekly rate = 1-week paid vacation/Optional Sick Days
- ABC Trooper’s Provider/Parent Agreement Form: Hours/Fees/Two Week Notices (13)
Do you agree to all the terms of Step 3?
Step 4: Forms Must be Completed or Reviewed Before Enrollment
- Identification & Emergency Information
- Consent for Emergency Medical Treatment
- ABC Trooper’s Child Care does have liability insurance ____Affidavit for No insurance
- Notification of Parent’s Rights Form
- Caregiver Background Ch
- Family Day Care Consumer Awareness Information
- Parent Notification if licensed for 8 or 14 children
- Immunization Records within the first 30 days of enrollment
- Pre-admission Health History
- Nebulizer Consent form
- Unusual Incident/Injury Report
- Sick Forms: __Keep Me Home __Too Sick __Backup plan __ Health Consultant __Payment still required.
- IOU Contracts
- Written Permission to give medication to your sick child along with a Doctor’s note
Do you agree to all the terms of Step 4?
Parent/Guardian's Electronic Signature
Any notes/additional information you'd like us to know?
Please fill out
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