* Required Information
Application and terms of admission


Authorized Pickup form
Primary
Person Authorized to pick up daily:
Secondary

I give my permission for the people listed below to pick up my child if the parents/guardians cannot be reached.

ALL INDIVIDUAL MUST BE PREPARED TO PRESENT A PICTURE INDENTIFICATION WHEN PICKING UP YOUR CHILD.
CONTINGENT:


Picking up: If someone other than the contingent is picking up your child, let us know in advance, in writing, who the person will be, please inform the individual that picture identification will be required when picking up. Be certain everyone “Signs out” your child, with the adult name, child’s name, date and time. There is a daily sign out sheet at the entrance of the office. All children must be signed in and out daily. If there is anyone who is NOT to pick up your child, let us know – “In Writing”. In special cases when the “other” parent or guardian is restricted from pickups. We MUST have the court order on file, in advance.
Consent
Emergency Medical Plan: In case an illness. accident, or injury occurs to the child, the parents/guardians listed below will be notified promptly. If the parent cannot be contacted, the center will use the information on the emergency contact card to notify the emergency contact listed. ALL INFORMATION ON THE EMEGENCY CONTACT CARD MUST BE UP TO DATE AT ALL TIMES. PARENT MUST UPDATE EMERGENCY CARD WHEN CHANGES OCCUR IMMEDIATELY.
If the services of practitioners are needed for a child who is exempt from medical care on religious ground please list the information below and we will attempt to contact them immediately.

Consent for emergency medical care: If an emergency or accident needs immediate care, first aid may be given and the local emergency personnel may be called. If further treatment is necessary, the child may be transported to the hospital. Kings & Queens Children’s Academy will try to contact the parent or guardian first. If unable to contact parent/guardian, Doctors or practitioner the Childcare Center reserves the right to determine the need for emergency treatment. Parents/guardian will hold the Childcare Center harmless and assume the responsibility for any expense incurred.

Consent for walking Field Trip: I hereby give my consent to the Childcare Center, Kings & Queens Children’s Academy to take my child on walking trips, special excursions to places of interest, and public parks and facilities with the understanding that such trips are under supervision of personnel of the Childcare Center and that precaution are taken to insure the health and safety of my child/children. My Child is in good physical condition and can participate in all normal activities. In case of injury my child may receive first aid from childcare personnel or emergency personnel as necessary.

Consent to photograph: We like to take pictures to share special moments of the children’s activities with parents. We do not intentionally use photos for publicity unless we get written permission from the parent/guardian. I give consent to take/use pictures for the purpose of projects, room displays and special moments.

Consent to film or video of children: Children are filmed for security/safety purposes. This recording is observed by management / staff and can be reviewed by DCFS and authorities. I give consent for my child to be filmed or videoed.

Release of personal information: We do not release any personal information of the child or the family to anyone other than DCFS or the proper authorities with proper identification, reasons and verification.

Fire and Tornado drill: A fire drill is done monthly. We spend some time talking about the fire drill and the procedure we follow if weather is cold or wet. We also practice tornado drills throughout the tornado season.

Discipline: We discipline by showing our love and respect for your child. We use our flexibility by changing the activities first, when appropriate. We act consistently so the children will know what we expect of them. If these measures fail, for children two years or older we give a “time out” (not to exceed one minute per year of age) followed by a short explanation of why the “time out” was appropriate.

We the Parent(s)/Guardian(s) have read and agree to the application and terms of admission. The form(s) Notices, Policies, Terms and conditions of the most current tuition schedule and to update emergency contact information as it changes.
REQUIRED CHILD’S INFORMATION
  • ANDORRA (+376)
  • UNITED ARAB EMIRATES (+971)
  • AFGHANISTAN (+93)
  • ANTIGUA AND BARBUDA (+1268)
  • ANGUILLA (+1264)
  • ALBANIA (+355)
  • ARMENIA (+374)
  • NETHERLANDS ANTILLES (+599)
  • ANGOLA (+244)
  • ARGENTINA (+54)
  • AMERICAN SAMOA (+1684)
  • AUSTRIA (+43)
  • AUSTRALIA (+61)
  • ARUBA (+297)
  • AZERBAIJAN (+994)
  • BOSNIA AND HERZEGOVINA (+387)
  • BARBADOS (+1246)
  • BANGLADESH (+880)
  • BELGIUM (+32)
  • BURKINA FASO (+226)
  • BULGARIA (+359)
  • BAHRAIN (+973)
  • BURUNDI (+257)
  • BENIN (+229)
  • SAINT BARTHELEMY (+590)
  • BERMUDA (+1441)
  • BRUNEI DARUSSALAM (+673)
  • BOLIVIA (+591)
  • BRAZIL (+55)
  • BAHAMAS (+1242)
  • BHUTAN (+975)
  • BOTSWANA (+267)
  • BELARUS (+375)
  • BELIZE (+501)
  • CANADA (+1)
  • COCOS (KEELING) ISLANDS (+61)
  • CONGO,THE DEMOCRATIC REPUBLIC OF THE (+243)
  • CENTRAL AFRICAN REPUBLIC (+236)
  • CONGO (+242)
  • SWITZERLAND (+41)
  • COTE D IVOIRE (+225)
  • COOK ISLANDS (+682)
  • CHILE (+56)
  • CAMEROON (+237)
  • CHINA (+86)
  • COLOMBIA (+57)
  • COSTA RICA (+506)
  • CUBA (+53)
  • CAPE VERDE (+238)
  • CHRISTMAS ISLAND (+61)
  • CYPRUS (+357)
  • CZECH REPUBLIC (+420)
  • GERMANY (+49)
  • DJIBOUTI (+253)
  • DENMARK (+45)
  • DOMINICA (+1767)
  • DOMINICAN REPUBLIC (+1809)
  • ALGERIA (+213)
  • ECUADOR (+593)
  • ESTONIA (+372)
  • EGYPT (+20)
  • ERITREA (+291)
  • SPAIN (+34)
  • ETHIOPIA (+251)
  • FINLAND (+358)
  • FIJI (+679)
  • FALKLAND ISLANDS (MALVINAS) (+500)
  • MICRONESIA,FEDERATED STATES OF (+691)
  • FAROE ISLANDS (+298)
  • FRANCE (+33)
  • GABON (+241)
  • UNITED KINGDOM (+44)
  • GRENADA (+1473)
  • GEORGIA (+995)
  • GHANA (+233)
  • GIBRALTAR (+350)
  • GREENLAND (+299)
  • GAMBIA (+220)
  • GUINEA (+224)
  • EQUATORIAL GUINEA (+240)
  • GREECE (+30)
  • GUERNSEY (+44)
  • GUATEMALA (+502)
  • GUAM (+1671)
  • GUINEA-BISSAU (+245)
  • GUYANA (+592)
  • HONG KONG (+852)
  • HONDURAS (+504)
  • CROATIA (+385)
  • HAITI (+509)
  • HUNGARY (+36)
  • INDONESIA (+62)
  • IRELAND (+353)
  • ISRAEL (+972)
  • ISLE OF MAN (+44)
  • INDIA (+91)
  • IRAQ (+964)
  • IRAN,ISLAMIC REPUBLIC OF (+98)
  • ICELAND (+354)
  • ITALY (+39)
  • JAMAICA (+1876)
  • JORDAN (+962)
  • JAPAN (+81)
  • JERSEY (+44)
  • KENYA (+254)
  • KYRGYZSTAN (+996)
  • CAMBODIA (+855)
  • KIRIBATI (+686)
  • COMOROS (+269)
  • SAINT KITTS AND NEVIS (+1869)
  • KOREA DEMOCRATIC PEOPLES REPUBLIC OF (+850)
  • KOREA REPUBLIC OF (+82)
  • KUWAIT (+965)
  • CAYMAN ISLANDS (+1345)
  • KAZAKSTAN (+7)
  • LAO PEOPLES DEMOCRATIC REPUBLIC (+856)
  • LEBANON (+961)
  • SAINT LUCIA (+1758)
  • LIECHTENSTEIN (+423)
  • SRI LANKA (+94)
  • LIBERIA (+231)
  • LESOTHO (+266)
  • LITHUANIA (+370)
  • LUXEMBOURG (+352)
  • LATVIA (+371)
  • LIBYAN ARAB JAMAHIRIYA (+218)
  • MOROCCO (+212)
  • MONACO (+377)
  • MOLDOVA,REPUBLIC OF (+373)
  • MONTENEGRO (+382)
  • SAINT MARTIN (+1599)
  • MADAGASCAR (+261)
  • MARSHALL ISLANDS (+692)
  • MACEDONIA,THE FORMER YUGOSLAV REPUBLIC OF (+389)
  • MALI (+223)
  • MYANMAR (+95)
  • MONGOLIA (+976)
  • MACAU (+853)
  • NORTHERN MARIANA ISLANDS (+1670)
  • MAURITANIA (+222)
  • MONTSERRAT (+1664)
  • MALTA (+356)
  • MAURITIUS (+230)
  • MALDIVES (+960)
  • MALAWI (+265)
  • MEXICO (+52)
  • MALAYSIA (+60)
  • MOZAMBIQUE (+258)
  • NAMIBIA (+264)
  • NEW CALEDONIA (+687)
  • NIGER (+227)
  • NIGERIA (+234)
  • NICARAGUA (+505)
  • NETHERLANDS (+31)
  • NORWAY (+47)
  • NEPAL (+977)
  • NAURU (+674)
  • NIUE (+683)
  • NEW ZEALAND (+64)
  • OMAN (+968)
  • PANAMA (+507)
  • PERU (+51)
  • FRENCH POLYNESIA (+689)
  • PAPUA NEW GUINEA (+675)
  • PHILIPPINES (+63)
  • PAKISTAN (+92)
  • POLAND (+48)
  • SAINT PIERRE AND MIQUELON (+508)
  • PITCAIRN (+870)
  • PUERTO RICO (+1)
  • PORTUGAL (+351)
  • PALAU (+680)
  • PARAGUAY (+595)
  • QATAR (+974)
  • ROMANIA (+40)
  • SERBIA (+381)
  • RUSSIAN FEDERATION (+7)
  • RWANDA (+250)
  • SAUDI ARABIA (+966)
  • SOLOMON ISLANDS (+677)
  • SEYCHELLES (+248)
  • SUDAN (+249)
  • SWEDEN (+46)
  • SINGAPORE (+65)
  • SAINT HELENA (+290)
  • SLOVENIA (+386)
  • SLOVAKIA (+421)
  • SIERRA LEONE (+232)
  • SAN MARINO (+378)
  • SENEGAL (+221)
  • SOMALIA (+252)
  • SURINAME (+597)
  • SAO TOME AND PRINCIPE (+239)
  • EL SALVADOR (+503)
  • SYRIAN ARAB REPUBLIC (+963)
  • SWAZILAND (+268)
  • TURKS AND CAICOS ISLANDS (+1649)
  • CHAD (+235)
  • TOGO (+228)
  • THAILAND (+66)
  • TAJIKISTAN (+992)
  • TOKELAU (+690)
  • TIMOR-LESTE (+670)
  • TURKMENISTAN (+993)
  • TUNISIA (+216)
  • TONGA (+676)
  • TURKEY (+90)
  • TRINIDAD AND TOBAGO (+1868)
  • TUVALU (+688)
  • TAIWAN,PROVINCE OF CHINA (+886)
  • TANZANIA,UNITED REPUBLIC OF (+255)
  • UKRAINE (+380)
  • UGANDA (+256)
  • UNITED STATES (+1)
  • URUGUAY (+598)
  • UZBEKISTAN (+998)
  • HOLY SEE (VATICAN CITY STATE) (+39)
  • SAINT VINCENT AND THE GRENADINES (+1784)
  • VENEZUELA (+58)
  • VIRGIN ISLANDS,BRITISH (+1284)
  • VIRGIN ISLANDS,U.S. (+1340)
  • VIET NAM (+84)
  • VANUATU (+678)
  • WALLIS AND FUTUNA (+681)
  • SAMOA (+685)
  • KOSOVO (+381)
  • YEMEN (+967)
  • MAYOTTE (+262)
  • SOUTH AFRICA (+27)
  • ZAMBIA (+260)
  • ZIMBABWE (+263)

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