Enrollment Forms

Cherry Preschool Enrollment Forms

CHILD & FAMILY HISTORY FORM

A Child and Family History form is required by DCFS and helps teachers to understand and best meet the needs of the children attending Cherry Preschool. The information you share helps us to understand and validate each child's experience. Cherry Preschool respects the diverse composition of its families and is committed to protecting each family's right to privacy. The information you provide is strictly confidential and will not be shared with any person, agency, or school without your written permission.

The Department of Children and Family Services requires that all preschool programs obtain from parents of newly enrolled children a copy of their child’s birth certificate or equivalent documentation, such as a passport. This mandate is referred to in Section 407.250 of the Illinois Licensing Standards and relates to The Missing Children Records Act. Per DCFS requirements, if the parent or guardian fails to submit proof of the child’s identify within the 30 day time frame, we are required by law to notify the Illinois State Police or local law enforcement agency.

DCFS also mandates that you submit a current "Certificate of Child Health Examination" for your child.
Forms may be securely uploaded when you submit this document or emailed/mailed to the school.

Child's Name(Required)
First Last

Name your child wants to be called at school(Required)

Date of birth(Required)
MM slash DD slash YYYY

Which of the following best describes your child?(Required)
Asian or Pacific Islander
Black or Arican American
Hispanic or Latino
Native American or Native Alaskan
White or Caucasian
Multiracial or Biracial

Parental/Guardian Information

DCFS requires that we collect certain information for each parent/guardian. Please mark fields N/A if not applicable:

Parent/Guardian #1(Required)
First Last

Parent/Guardian #1 - Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian #1 - Cell Phone(Required)

Parent/Guardian #1 - Email(Required)
Enter Email Confirm Email

Parent/Guardian #1 - Employer's Name(Required)

Parent/Guardian #1 - Occupation(Required)

Parent/Guardian #1 - Employer's Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian #1 - Work Phone(Required)

Parent/Guardian #1 - Former Occupations, Interests, Hobbies(Required)

Does Parent/Guardian #1 share legal responsibility for the child with another Parent/Guardian?(Required)

Yes

No

Parent/Guardian #2(Required)
First Last

Does Parent/Guardian #2 reside at the same address as Parent/Guardian #1?(Required)

Yes

No

Parent/Guardian #2 - Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian #2 - Cell Phone(Required)

Parent/Guardian #2 - Email(Required)
Enter Email Confirm Email

Parent/Guardian #2 - Occupation(Required)

Parent/Guardian #2 - Employer's Name(Required)

Parent/Guardian #2 - Employer's Address(Required)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian #2 - Work Phone(Required)

Parent/Guardian #2 - Former Occupations, Interests, Hobbies(Required)

Sibling Information

Does your child have any siblings?(Required)

Yes

No

Sibling #1 - Name(Required)
First

Date Of Birth(Required)
MM slash DD slash YYYY

School/Grade(Required)

Add Sibling #2
Add sibling #2

Sibling #2 - Name
First

Date Of Birth
MM slash DD slash YYYY

School/Grade

Add sibling #3
Add sibling #3

Sibling #3 - Name
First

Date Of Birth
MM slash DD slash YYYY

School/Grade

Add sibling #4
Add sibling #4

Sibling #4 - Name
First

Date Of Birth
MM slash DD slash YYYY

School/Grade

Family Information

What lanuguages are spoken at home?(Required)

If parents are divorced or seprated, please share any important information regarding custody and living arrangements:

Please share any other family situations that would be helpful for your child's teacher to know: (e.g:adoption of child/sibling, separation/divorce, blended family, recent/pending move, recent death/loss, foster care, etc)

Are there any classroom activities that your child may not participate in due to your families religious beliefs? (e.g.: music, dancing, snacks, birthday celebrations, etc.)

Does your child have a regular caregiver?(Required)

Yes

No

How many days of the week and how many hours per day?(Required)

Does your child have a sibling with an identified developmental delay or disability?(Required)

Yes

No

Please explain:(Required)

Medical and Developmental History

Was your child a full-term baby?(Required)

Yes

No

If not, how many weeks?(Required)

Are there any special factors concerning pregnancy or delivery. (Answer in terms of biological/birth parent if your child joined your family through adoption or is in your foster care.)(Required)

Yes

No

Please describe.(Required)

Are there any special circumstances in your child's early development that we should be aware of (e.g.: extensive hospitalization, prolonged separaton from primary caregiver, change of custody.)(Required)

Yes

No

Please describe.(Required)

Does your child receive support service/therapies in any area of development or have any special needs that have been identified (i.e.:speech and/or language delays; physical disabilities; developmental delays; ,motor or sensory integration issues; social/emotional/behavioral difficulties)?(Required)

Yes

No

Please explain.(Required)

My child has non-food-based allergies (e.g. havy fever, pet dander, dust, mold, etc)(Required)

Yes

No

Please explain:(Required)

My child has non-medical dietary restrictions (i.e.: religious or parental preference, kosher, vegetarian, vegan, etc.)(Required)

Yes

No

Please explain:(Required)

Allergy & Medical Conditions

IF YOU CHECK THE BOX FOR ANY OF THE FOLLOWING, YOU WILL BE SENT AN ADDITIONAL ALLERGY/MEDICAL PACKET THAT MUST BE COMPLETED BY BOTH THE PARENT/GUARDIAN & YOUR CHILD'S PHYSICIAN PRIOR TO THE START OF SCHOOL

Untitled
My child has asthma
My child has food allergies that require a special diet
My child has a serious medical condition that may require ,monitoring or special treatment at school(e.g. diabetes, cancer, cystic fibrosis, seizure disorder, etc.)
My child takes medicine that might have to be administered at school

Behavior & Discipline

What do you see as your child's strengths?(Required)

What activities does your child like to do most?(Required)

What do you find is the most difficult thing about your child's behavior to manage?(Required)

How do you think your child will handle separation issues at the beginning of the school year?(Required)

Please descibe any specific situations in which your child becomes tense, afraid, or angry.(Required)

In general, how do you limit or discipline your child?(Required)

Is your child toilet trained?(Required)

Yes

No

Please share any information you would like the school to know regarding your child's toilet training you would like the teacher to know:

Does your child nap?(Required)

Yes

No

Sometimes

What hours?

What is your child's bedtime?(Required)

Please share any other information you would like the school to know regarding your child's sleep schedule:

What do you hope your child will gain from this coming year at Cherry Preschool? Please share your goals for your child:(Required)

Has your child had any previous experience with playgroups, preschool, day care, camp, etc.?(Required)

Yes

No

Group Experience #1(Required)

When(Required)
MM slash DD slash YYYY

Was parent/guardian included in experience?(Required)

Yes

No

Group Experience #2

When
MM slash DD slash YYYY

Was parent/guardian included in experience?

Yes

No

Group Experience #3

When
MM slash DD slash YYYY

Was parent/guardian included in experience?

Yes

No

Are you a new Cherry Preschool family?(Required)

Yes

No

How did you learn about Cherry Preschool?(Required)

Friend/Colleague

Social Media

Web Search

Pediatrician/Therapist

Advertisement

Lawn Sign

Other

Name of friend or colleague who referred you(Required)

Which social media platform? Instagram or Facebook(Required)

Name of person completing form(Required)
First Last

Signature(Required)

CHERRY PRESCHOOL TUITION POLICY AGREEMENT

Families are expected to sign up at MyProCare.com to view their accounts, obtain receipts and view statements.

PAYMENT SCHEDULE
Payment Schedules are based on nine monthly payments per year beginning May 1 and ending with January 1. Families enrolling later than May 1 or receiving tuition assistance will follow a different payment schedule that may continue through April 1.

PAYMENT OPTIONS
All families are required to enroll in automatic tuition payments. A valid credit card or bank account (ACH) must be securely maintained on file prior to the start of the program and throughout enrollment.
Families may elect to pay annual tuition in full by check prior to the start of the school year; however, a valid credit card or bank account (ACH) must still be maintained on file for incidental charges. Incidental charges may include, but are not limited to, late pickup fees, enrichment program fees, returned payment fees, and any other authorized charges incurred.
Tuition and any applicable fees will be processed automatically in accordance with the school’s established billing schedule. By enrolling, you authorize Cherry Preschool to charge the payment method on file for all tuition, fees, and incidental charges, as applicable.
Families may select their preferred payment method (credit card or ACH). Payments made by credit card may be subject to a processing fee. Any such fee will not exceed the actual cost of processing the transaction and will be clearly disclosed in advance. No surcharge will be applied to payments made via ACH.
If a payment is declined or returned for any reason, the family is responsible for promptly updating their payment information. Cherry Preschool reserves the right to reprocess declined payments and assess any applicable late or processing fees.
Failure to maintain a valid payment method on file, or repeated declined payments, may result in suspension of services and/or termination of enrollment.

POLICY ON PROMPT PAYMENT
Families are expected to make monthly payments by the first day of the month. If payment is NOT received within the month due, assuming no alternate arrangement has been made with the Financial Manager, a late fee of $10 may be assessed.

POLICY ON WITHDRAWING FROM PRESCHOOL
Cherry Preschool is private and independent, relying on tuition to meet our commitments for staff and facility expenses. No refunds are given for time missed because of extended illness or vacation. Withdrawal of a child from a program has serious financial consequences for the preschool. If a student withdraws from Cherry Preschool, families are still expected to pay all tuition invoiced prior to the withdrawl.

Name(Required)
First Last

Signature(Required)

LATE PICK UP POLICY

The Illinois Department of Children and Family Services requires that all licensed schools have a written late pick up policy. Parents/guardians are required to read the policy and sign an acknowledgement.

Late pickups are a problem on many levels. First and foremost, it is very difficult for children. Children become anxious and worried when they aren’t picked up with their peers. They are afraid they have been forgotten. Late pickups are difficult for teachers who need to clean up their classrooms and either eat lunch or pick up their own children from school. For the administrators, at times there is only one of us in the office and it is difficult to provide safe (and nurturing) supervision while attending to parents and the phone.

It is Cherry Preschool’s responsibility to protect and look out for the well being of all children until they are picked up when school has ended.

If you are late for pick up, we will begin calling all phone numbers available for the child’s parents/guardians five minutes after the class has been dismissed. If we cannot reach you within 10 minutes after dismissal, we will continue to call all emergency contacts listed on the general release form. If we are not able to get in touch with any of the emergency numbers within 1 hour after dismissal, we will contact the police to request assistance in finding emergency contacts. Therefore, it is very important that we have up-to-date emergency contact numbers on file.

The staff will not hold the child responsible for any late pick- ups. That discussion will only be with the parents or guardians, never with the child.

Fines for late pick-ups for morning and afternoon classes, lunch programs and the after care program are as follows:

• $1/minute for the first 15 minutes

• $5/minute after that

For chronic late lunch or after care offenders: At the 4th offense, the child will be dropped from the program. Late pick up fines are donated to the Staff Appreciation Fund.

We appreciate your understanding about this important policy.

Name(Required)
First Last

Signature(Required)

GUIDANCE & DISCIPLINE POLICY

The Illinois Department of Children and Family Services and NAEYC require that all licensed schools have a written guidance and discipline policy. Parent/guardians are required to read the policy and sign a document stating that they have done so at the time of their child's enrollment.

GUIDANCE AND DISCIPLINE POLICY

The goal of discipline is to teach children to function in a social setting with civility and respect. Discipline is not punishment, but rather a way to help children maintain self-control, follow the agreed upon rules for classroom behavior, and treat one another with kindness and acceptance. At Cherry Preschool, we believe discipline involves teacher planning to prevent problems, simple and clearly stated rules and expectations, redirection when problems arise, and appropriate adult intervention when necessary. Each classroom, under the guidance of the teachers, develops and posts its own rules for the protection and welfare of the group. The basic code of behavior for Cherry Preschool is:
● Respect one another -- do not hurt anyone physically or verbally.
● Include one another -- You can't say you can't play.
● Keep everyone safe -- do not act in a way that could be dangerous to yourself or others.
● Respect our environment -- do not intentionally damage toys, equipment, or property. TEACHERS' ROLE
Staff members are responsible for handling discipline for the children under their care. This is to be done in a positive manner, privately and individually. Discipline is used when a child’s behavior becomes disruptive to the functioning of the class, is disturbing to other children, or is potentially dangerous for the child or other children. In general, children who have lost control of their behavior are given the opportunity to regain control in a quiet place in the room. This is not referred to as time out. A teacher will be near the child and removal from the group will not exceed one minute per year of age. If a child needs to be removed from the classroom, the teacher must first intercom the office for additional help. If a child hurts him/herself or another child, or behaves in an unusually disruptive manner, the teacher must document this behavior in writing on an Accident Report or Incident Report form. As a DCFS licensed program that adheres to NAEYC standards, we agree that the following are never permitted:
Physical punishment such as shaking or hitting, psychological abuse or coercion, abusive language, threats or derogatory remarks, withholding or threatening to withhold food or bathroom privileges, threats of any sort, public or private humiliation, discipline for toileting accidents, emotional abuse (shaming, rejecting, isolating)
The teachers work with children to help them understand and verbalize their feelings. Limits and consequences are clearly explained, consistently enforced, and discussed with children as part of any disciplinary action. When a specific plan has been developed to respond to a child's pattern of unacceptable behavior, all staff members who work with that child will be aware of the plan and responsible for its implementation.
PARENTS'/GUARDIANS' ROLE

Parents/guardians receive a copy of the rules of conduct developed by their child's class. We ask that they reinforce these rules at home. We welcome parental input as to what works best for each child, and whenever possible, we try to be consistent. Cherry Preschool encourages open communication with parents/guardians to help children behave appropriately in the preschool setting. In addition to formal conferences, teachers will inform parents if behavior problems persist and may consult with the Child Development & Inclusion Director and/or Executive Director. Parents may be asked to attend extra conferences to collaborate on solutions.
DISCHARGE AND TRANSITION POLICY

We recognize that all children develop social skills and adjust to the school environment at their own individual rate, and that there is a wide range of normal behavior in adjusting to the preschool setting. If a child is having an unusual amount of difficulty assimilating into the group setting, the school will work with the child's family to solve the problem with the support of our Child Development and Inclusion Director or Executive Director, a staff consultant, and parental conferences. If interventions are unsuccessful, the Child Development and Inclusion Director and Executive Director will work with the family to find a more appropriate placement for their child, based on the following Department of Children and Family Services regulation:
“Infants, toddlers, and preschool age children who, after documented attempts have been made to meet the child’s individual needs, demonstrate an inability to benefit from the type of care offered by the facility, or whose presence is detrimental to the group, shall be transitioned to an alternative program.
For infants, toddlers, and preschool aged children, in all instances when a facility decides that it is in the best interest of the child to transition to a different program, the child’s and parents’ needs shall be considered by planning with the parents to identify the new program and working with the parents and pending program on a transition plan designed to ensure continuity of services to meet the child’s needs. “
PROCESS FOR ADDRESSING CHALLENGING BEHAVIOR:

When a child’s behavior is negatively impacting their health and safety or the health and safety of the classroom community, the following process will be followed:
1. The Child Development and Inclusion Director and/or Executive Director will meet with the classroom teachers to discuss the situation. The Child Development and Inclusion Director and/or the Executive Director will observe the child in the classroom. Parents/caregivers will be notified that the child is struggling in the classroom.
2. A meeting will be held with the teachers, parents/caregivers, and the Child Development and Inclusion Director or Executive Director. If there are concerns that the child’s behavior is a symptom of an undiagnosed disability or developmental delay, the Child Development and Inclusion Director will provide referrals to outside agencies for evaluation. A plan will be created to provide interventions to support the child, and the Child Development and Inclusion Director will determine how progress will be measured and tracked.
3. The teachers will work with the Child Development and Inclusion Director to put the plan in place and track progress. The school will communicate regularly with the family about the child’s progress. After an agreed upon period of time, the team will again meet with parents to discuss progress.
4. If the child responds to the interventions and Cherry Preschool feels that the child can continue at the school in a manner that is safe for the entire classroom, the child will continue their enrollment for the remainder of the school year. If the child does not respond to interventions, the Child Development and Inclusion Coordinator and/or Executive Director will work with the family to transition the child to a more appropriate setting for the child.
Cherry Preschool is committed to exhausting all means within its disposal to keep a child in our program. Ultimately, however, the welfare of the entire class must take precedence over the needs of any given child.

Name(Required)
First Last

Signature(Required)

Would you like to upload a copy of your child's Birth Certificate or Certificate of Child Health Examination?(Required)

Yes

No

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