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ADMISSION AGREEMENT

I agree to abide by the following rules of Sunflower Preschool. At the time of admission, provide the school with the following completed documents:
  • Emergency Information
  • Parent's Rights
  • Children's Rights
  • Parent's Health Report
  • Consent for medical treatment
  • Physician's Health Report with up-to-date immunizations
  • Blanket Permission Slip
  • Disaster Preparedness Kit

Click here to download Admission form

Download Form
I agree to notify the school at least one week in advance when withdrawing my child from the school. If Sunflower Preschool is not notified, I will be responsible for one full week’s tuition.

I understand that the school closes at 6:00 P.M. and if late, I will be assessed a late fee of $20 for the first fifteen minutes, or any portion thereof. After fifteen minutes, the fee goes up $5.00 for every 5-minute increment thereafter (not $1.00 per minute).

Sunflower does not provide breakfast, but a bowl of cereal can be purchased for 50 cents. Children may bring their own breakfast but it must be eaten by 8:30 A.M. in order that the classrooms may be prepped for the day.

Classes start at 9:00 A.M. As a courtesy to the staff and other students, I agree to bring my child no later than 9:00 A.M. Morning is a crucial time of the day for your child’s learning. If you absolutely have to be late, please call so that we may include your child in the lunch count: 310-371-373 l .

I agree to pay the tuition in a timely manner. And I understand that if timely payments are not made, I may be asked to take my child out of school. I also understand if for whatever reason my child is absent from school during the week, I will pay the 2,3, or 4-day rate according to the tuition schedule–not a pro-rated 5-day rate. I also understand I will be responsible for a minimum of two day’s tuition per week.

If my child fails to adjust to group social behavior and if, after extensive attempts to remediate the child ‘ s behavior , it is detem1ined that the child poses a threat to the other children or teachers, I understand that my child will be asked to leave the school.

Sunflower is not responsible for refunds. Retain all your receipts for tax purposes. I understand Sunflower does not furnish a printout of my payments at the end of the year.

Please read and indicate your agreement by signing below. Return it to the Director together with all the completed admission papers upon enrollment in Sunflower Preschool.

PHYSICIAN'S REPORT-CHILD CARE CENTERS

(CHILD'S PRE-ADMISSION HEALTH EVALUATION)

PART A - PARENT'S CONSENT (TO BE COMPLETED BY PARENT)

    , born sbeing studied for readiness to enter .This Child Care Center/School provides a program which extends from
    days a week.
    Please provide a report on above-named child using the form below. I hereby authorize release of medical information contained in this report to the above-named Child Care Center.

    (SIGNATURE OF PARENT, GUARDIAN, OR CHILD 'S AUTHORIZED REPRESENTATIVE)

    PART B - PHYSICIAN'S REPORT (TO BE COMPLETED BY PHYSICIAN)

      ADDITIONAL PERSONS WHO MAY BE CALLED IN AN EMERGENCY

      Vaccine 1st 2nd 3rd 4rd 5rd
      Polio (OPC & IPV)
      DTP/DTaP/DT/Td
      MMR
      HIB MENINGITIS
      HEPATITIS B
      VERICELLA

      Screening of TB risk factors (listing on reverse side)




      Communicable TB disease not present.
        reviewed the above information with parent/guardian.
      • Physician:
      • Address:
      • Telephone:
      • Date of physical exam
      • Date this form completed
      • Signature

      RISK FACTORS FOR TB IN CHILDREN:

      • Have a family member or contacts with a history of confirmed or suspected TB. Are in foreign-born families and from high-prevalence countries (Asia, Africa, Central and South America).
      • Live in out-of-home placements. Have, or are suspected to have, HIV infection. Live with an adult with HIV seropositlvity.
      • Live with an adult who has been incarcerated In the last five years.
      • Live among, or are frequently exposed to, individuals who are homeless, migrant farm workers, users of street drugs, or residentsin nursing homes. Have abnormalities on chest X-ray suggestive of TB. Have clinical evidence of TB.
      • Consult with your local health department's TB control program on any aspects of TB prevention and treatment.

      RISK FACTORS FOR TB IN CHILDREN:

      • Have a family member or contacts with a history of confirmed or suspected TB. Are in foreign-born families and from high-prevalence countries (Asia, Africa, Central and South America).
      • Live in out-of-home placements. Have, or are suspected to have, HIV infection. Live with an adult with HIV seropositlvity.
      • Live with an adult who has been incarcerated In the last five years.
      • Live among, or are frequently exposed to, individuals who are homeless, migrant farm workers, users of street drugs, or residentsin nursing homes. Have abnormalities on chest X-ray suggestive of TB. Have clinical evidence of TB.
      • Consult with your local health department's TB control program on any aspects of TB prevention and treatment.

      PERSONAL RIGHTS

      Chlld Care Centers

      Personal Rights, See Section 101223 for waiver conditions applicable to Child Care Centers.
      1. Child Care Centers. Each child receiving services from a Child Care Center shall have rights which include, but are not limited to, the following:
      • To be accorded dignity in his/her personal relationships with staff and other persons.
      • To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
      • To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
      • To be informed, and to have his/her authorized representative, if any, informed by the licensee of the provisions of ·law regarding complaints including, but not limi1ed to, the address and telephone number of the complaint receiving unit of the licensing agency and of information regarding confidentiality.
      • To be free to attend religious services or activities of his/her choice and to have visits from the spiritual advisor of his/her choice. Attendance at religious services, either in or outside the facility, shall be on a completely voluntary basis. In Child Care Centers, decisions concerning attendance at religious services or visits from spiritual advisors shall be made by the parent(s), or guardian(s) of the child.
      • Not to be locked in any room, building, or facility premises by day or night.
      • Not to be placed in any restraining device, except a supportive restraint approved in advance by the licensing agency.
      THE REPRESENTATIVE/PARENT/GUARDIAN HAS THE RIGHT TO BE INFORMED OF THE APPROPRIATE LICENSING AGENCY TO CONTACT REGARDING COMPLAINTS, WHICH IS:

      DETACH HERE

      TO: PARENT/GUARDIAN/CHILD OR AUTHORIZED REPRESENTATIVE:
      PLACE IN CHILD’S FILE
      Upon satisfactory and full disclosure of the personal rights as explained, complete the following acknowledgment:

      ACKNOWLEDGMENT: I/We have been personally advised of, and have received a copy of the personal rights contained in the California Code of Regulations, Title 22, at the time of admission to:

      CHILD CARE CENTER NOTIFICATION OF PARENTS' RIGHTS

      PARENTS' RIGHTS

      As a Parent/Authorized Representative , you have the right to:
      1. Enter and inspect the child care center without advance notice whenever children are in care.
      2. File a complaint against the licensee with the licensing office and review the licensee’s public file kept by the licensing office.
      3. Review, at the child care center, reports of licensing visits and substantiated complaints against the licensee made during the last three years.
      4. Complain to the licensing office and inspect the child care center without discrimination or retaliation against you or your child.
      5. Request in writing that a parent not be allowed to visit your child or take your child from the child care center, provided you have shown a certified copy of a court order.
      6. Receive from the licensee the name, address and telephone number of the local licensing office.
      Licensing Office Name: CDSS Community Care licensing Division
      Licensing Office Address: 6167 Bristol Parkway, Suite 400, Culver City, CA 90230
      Licensing Office Telephone #: 310-337-4333

      7. Be informed by the licensee, upon request, of the name and type of association to the child care center for any adult who has been granted a criminal record exemption, and that the name of the person may also be obtained by contacting the local licensing office.

      8. Receive, from the licensee, the Caregiver Background Check Process form.

      NOTE: CALIFORNIA STATE LAW PROVIDES THAT THE LICENSEE MAY DENY ACCESS TO THE CHILD CARE CENTER TO A PARENT/AUTHORIZED REPRESENTATIVE IF THE BEHAVIOR OF THE PARENT/AUTHORIZED REPRESENTATIVE POSES A RISK TO CHILDREN IN CARE.

      ACKNOWLEDGEMENT OF NOTIFICATION OF PARENTS' RIGHTS

      (Parent/Authorized Representative Signature Required)

        I, the parent/authorized representative of , have received a copy of the "CHILD CARE CENTER NOTIFICATION OF PARENTS' RIGHTS" and the CAREGIVER BACKGROUND CHECK PROCESS form from the licensee.


        Signature (Parent/AuthorizedRepresentative)

        NOTE: This Acknowledgement must be kept In child's file and a copy of the Notification given to
        parent/authorized representative.
        For the Department of Justice "Registered Sex Offender"database go to www.meganslaw.ca.gov

        IMPORTANT INFORMATION FOR PARENTS

        CAREGIVER BACKGROUND CHECK PROCESS CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

        The California Department of Social Services works to protect the safety of children in child care by licensing child care centers and family child care homes. Our highest priority is to be sure that children are in safe and healthy child care settings. California law requires a background check for any adult who owns, lives in, or works in a licensed child care home or center. Each of these adults must submit fingerprints so that a background check can be done to see if they have any history of crime. If we find that a person has been convicted of a crime other than a minor traffic violation or a marijuana­ related offense covered by the marijuana reform legislation codified at Health and S aaty Code sections 11361.5 and 11361.7, he/she cannot work or live in the licensed child care home or center unless approved by the Department. This approval is called an exemption. A person convicted of a crime such as murder, rape, torture, kidnapping, crimes of sexual violence or molestation against children cannot by law be given an exemption that would allow them to own, live in or work in a licensed child care home or center. If the crime was a felony or a serious misdemeanor, the person must leave the facility while the request is being reviewed. If the crime is less serious, he/she may be allowed to remain in the licensed child care home or center while the exemption request is being reviewed.

        How the Exemption Request is Reviewed

        We request information from police departments, the FBI and the courts about the person’s record. We consider the type of crime, how many crimes there were, how long ago the crime happened and whether the person has been honest in what they told us. The person who needs the exemption must provide information about:
        • The crime
        • What they have done to change their life and obey the law
        • Whether they are working, going to school, or receiving training
        • Whether they have successfully completed a counseling or rehabilitation program
        The person also gives us reference letters from people who aren’t related to them who know about their history and their life now. We look at all these things very carefully in making our decision on exemptions. By law this information cannot be shared with the public.

        How to Obtain More Information

        As a parent or authorized representative of a child in licensed child care, you have the right to ask the licensed child care home or center whether anyone working or living there has an exemption. If you request this information, and there is a person with an exemption, the child care home or center must tell you the person’s name and how he or she is involved with the home or center and give you the name, address, and telephone number of the local licensing office. You may also get the person’s name by contacting the local licensing office. You may find the address arft:::I phone number on our website. The website address is http://ccld.ca.gov/contac t.htm.

        Disaster Preparedness Personal Emergency Kit Contents

        These items are meant to provide a feeling of comfort that comes with something “from home”, as well as to help sustain your child during an emergency situation. You may like to include a short personal note or family picture.
        Please..
        • Use a freezer storage plastic bag (the one-gallon-zip-lock type seems to work best).
        • Enclose only the suggested items listed below. Each classroom must hold supplies for all students and the teacher. If everyone sent just one "extra" the available space would quickly fill up.
        • Use a felt-tip marker and print in bold letters your child's name, room number and teacher's name on the outside of the bag.
        • After filling the bag, t,ape it tightly closed.
        • Do not staple bag closed.

        Six Items for the Penonal Emergency Kit

        1. The Disaster Preparedness Form (listed below). Place this in the bag so it can be read without tearing the bag open.
        2. One old sweat shirt or sweater.
        3. One small packet of Kleenex.

        4. One small packet of wet wipes.

        5. One 6-ounce can Of juice.

        6. Three small snack packages – items that are commercially vacuum-packed such as granola bars, peanuts, beef jerky, lifesavers, fruit rolls, etc.

        Please • no extra Items or quantities other than those listed. AND, no loose snacki or cracken that could be crushed, could spoil or could attract ants.

          Emergency Contact

          Persons to whom student maybe released:

          Out-of-State Emergency Contact

          Medical Information

          IDENTIFICATION AND EMERGENCY INFORMATION CHILD CARE CENTERS/FAMILY CHILD CARE HOMES

          To Be Completed by Parent or Authorized Representative

              CHILD'S NAME

              ADDRESS

              FATHER'S/GUARDIAN'S/FATHER'S DOMESTIC PARTNER'S NAME

              Home Address

              MOTHER'S/GUARDIAN'S/MOf HER'SDOMESTIC PARTNER'S NAME

              Home Address

              PERSON RESPONSIBLE FOR CHIL

            ADDITIONAL PERSONS WHO MAY BE CALLED IN AN EMERGENCY

            Name Address Telephone Relationship

            PHYSICIAN OR DENTIST TO BE CALLED IN AN EMERGENCY

              • IF PHYSICIAN CANNOf BE REACHED, WHAT ACTION SHOULD BE TAKEN?

              • Explain

            NAMES OF PERSONS AUTHORIZED TO TAKE CHILD FROM THE FACILITY

            (CHILD WILL NOT BE ALLOWED TO LEAVE WITH ANY OTHER PERSON WITHOUT WRITTEN AUTHORIZATION FROM PARENT OR AUTHORIZED REPRESENTATIVE)

            Name Address Telephone Relationship
            • SIGNATURE OF PARENT/GUARDIAN OR AUTHORIZED REPRESENTATIVE

            TO BE COMPLETED BY FACILITY DIRECTOR/ADMINISTRATOR/FAMILY CHILD CARE HOMES LICENSEE

            CONSENT FOR EMERGENCY MEDICAL TREATMENT­

            Child Care Centers Or Family Child Care Homes

            AS THE PARENT OR AUTHORIZED REPRESENTATIVE, I HEREBY GIVE CONSENT TO

              TO OBTAIN ALL EMERGENCY MEDICAL OR DENTAL CARE

              PRESCRIBED BY A DULY LICENSED PHYSICIAN (M.D.) OSTEOPATH (D.O.) OR DENTIST (D.D.S.) FOR

              THIS CARE MAY BE GIVEN UNDER

              WHATEVER CONDITIONS ARE NECESSARY TO PRESERVE THE LIFE, LIMB OR WELL BEING OF THE CHILD

              NAMED ABOVE

              CHILD HAS THE FOLLOWING MEDICATION ALLERGIES :



              PARENT OR AUTHORIZED REPRESENTATIVE SIGNATURE

              CHILD'S PREADMISSION HEALTH HISTORY-PARENT'S REPORT

                DEVELOPMENmt FtlSTORV (•For infants and preschool-age children only)

                PAST ILLNESSES - Check Illnesses that chlld has had and sneclfv annroxlmate dates of Illnesses:

                  • Date

                  • Date

                  • Date

                • DOES CHILD HAVE FREQUENT COLDS?

                DAILY ROUTINES (For Infants and preschool-age children only)

                • DIET PATTERN: (What does child usually eat tor these meals?)
                • WHAT ARE USUAL EATING HOURS?

                  IS CHILD TOILET TRAINED?*

                  • IF YES, AT WHAT STAGE:

                  • ARE BOWEL MOVEMENTS REGULAR?

                  • WHAT IS USUAL TIME?*

                • IS CHILD PRESENTLY UNDER A DOCTOR'S CARE?
                • DOES CHILD USE ANY SPECIAL DEVICE(S):
                • IF YES, NAME OF DOCTOR:
                • IF YES, WHAT KIND:
                • DOES CHILD TAKE PRESCRIBED MEDICATION(S)?
                • DOES CHILD USE ANY SPECIAL DEVICE(S) AT HOME?
                • IF YES, WHAT KIND AND ANY SIDE EFFECTS:
                • IF YES, WHAT KIND


                • PARENTS SIGNATURE

                Sunflower Preschool Blanket Permission Slip

                Please, initial each sentence to give permission for your child to participate in activities and sign below. Thank you!
                • Class walks: "Off Licensed" property. Ex. Nature walks, post office, library, local parks. You will be notified in class monthly calendars before any of these walks occur. For bigger field trips that require vehicle transportation you will get a separate permission slip.
                • Photographs of children. Ex. During activities, parties, field trips.
                • Photographs of children to be posted on our private Sunflower Families Facebook page. NOTE: PAGE IS INVITE ONLY . NO OUTSIDE FRIEND REQUESTS WILL BE ACCEPTED. PLEASE ADD YOUR EMAIL BELOW IF YOU WISH TO BE INVITED TO OUR SUNFLOWER FAMILIES FACEBOOK PAGE.
                • Water play on hot days.
                • Participation in inflatable bounce house jumping (summer only)
                • Class cooking projects. Some may require use of an electric griddle.
                • This document shall provide blanket permission for the aforementioned activities for the complete duration of a student's time at Sunflower Preschool, even when said child's care is interrupted by vacations and any other lapse of time.

                2400 Nelson Avenue, Redondo Beach,
                California 90278

                310-371-3731

                info@sunflower-preschool.com

                © 2021 Sunflower Preschool. | All Rights Reserved

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