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Location
3411 Delaware Ave, Kenner, LA 70065
Hotline
(504) 469-2418
Home
About
Enrollment
Pay Tution
Events
Contact Us
Schedule A Tour
Home
About
Enrollment
Pay Tution
Events
Contact Us
Schedule A Tour
Home
About
Enrollment
Pay Tution
Events
Contact Us
Schedule A Tour
Home
About
Enrollment
Pay Tution
Events
Contact Us
Schedule A Tour
Admission Form
Child Name
Date of birth
Address
Phone Number
With whom does the child live?
Mother's Name
Mother's Address
Mother's Home Phone
Cell Phone
Mother's Place and Hours of Employment
Mother's Work Address
Phone Number
Father's Name
Father's Address
Father's Home Number
Cell Phone
Father's Place and Hours of Employment
Father's Work Address
Phone Number
Person(s) authorized to pick up child other than parents/guardians
Person 1
Relationship
Phone Number
Person 2
Relationship
Phone Number
Person 3
Relationship
Phone Number
AUTHORIZATION FOR FIRST AID TREATMENT
Parent/Guardian Name
Child’s Name
Permission Granted For:
First aid treatment deemed necessary.
Parent’s Electronic Signature
Date
AUTHORIZATION FOR MEDICAL TREATMENT
Parent/Guardian Name
Child’s Name
Permission Granted For:
Emergency medical treatment.
Parent’s Electronic Signature
Date
AUTHORIZATION FOR PHOTOGRAPHS
Parent/Guardian Name
Child’s Name
Permission Granted For:
Emergency medical treatment.
Parent’s Electronic Signature
Date
TOPICAL OINTMENT APPLICATION AUTHORIZATION
Child’s Name
I give permission for the staff at Delaware Academy and Preschool to apply the following topical products to my child, whether center-provided or parent-provided:
1. Sunscreen
Yes
No
2. Insect Repellant
Yes
No
3. Diaper Rash Ointment
Yes
No
4. Baby Powder
Yes
No
Other (please specify):
This one-time authorization will remain in effect until another authorization is signed.
Parent's Signature
Date
I authorize the Center to allow my child to hold his/her bottle/sippy cup in his/her crib/cot.
Parent's Signature
Date
I authorize the center to use baby wipes on my child.
Parent's Signature
Date
PARENT/GUARDIAN AGREEMENT
Parent/Guardian's Name
Child's Name
I agree to pay any difference not covered by the childcare assistance program to Delaware Academy and Preschool, Inc. and am aware that Delaware Academy and Preschool, Inc. will take me to small claims court to retrieve any money owed by me. I am also aware that I will have to pay for court costs in addition to the money owed by me for services rendered.
Parent's Signature
Date
CASH PROGRAM
Parent/Guardian's Name
Child's Name
I agree to pay tuition and fees to Delaware Academy and Preschool, Inc. and am aware that Delaware Academy and Preschool, Inc. will take me to small claims court to retrieve any money owed by me. I am also aware that I will have to pay for court costs in addition to the money owed by me for services rendered.
Parent's Signature
Date
LATE FEE POLICY AGREEMENT
Parent/Guardian's Name
Child's Name
I do hereby agree to pay a late fee of $1.00 per minute per child if I pick up my child/children after 6:00 p.m. I am aware that payment MUST be made at that time, or the child/children cannot return to the Center until fees are paid. I am aware that Delaware Academy and Preschool, Inc. will take me to small claims court to retrieve any monies owed by me. I am also aware that I will have to pay for court costs in addition to the monies owed by me for services rendered.
Parent's Signature
Date
Children are only allowed to stay at the center for 10 consecutive hours a day!
Person 1
Relationship of Child
Person 2
Relationship of Child
Person 3
Relationship of Child
Person 4
Relationship of Child
I authorize the facility to secure emergency medical treatment for my child.
Parent's Signature
Date
Submit
