Little Explorers Enrollment Packet Clear form Print / Save as PDF Enrollment Packet Beautiful Minds Little Explorers A microschool program for toddlers and preschoolers Main Office (Rapid City) 2620 Jackson Blvd., Ste FRapid City, SD 57702 (605) 608-0833info@beautifulmindssd.com Two ways to complete this packetOnline: fill in each part below, then press Submit Enrollment Form at the bottom. Typing your full name in a signature line counts as your signature. Please bring or email copies of any custody papers or allergy action plans to the office.On paper: use Print / Save as PDF at the top, fill it out by hand, and return it to the Main Office. Welcome to Little Explorers Thank you for choosing Little Explorers. Our program gives children a safe, structured, and engaging place to learn and grow through consistent routines and positive relationships. This packet helps us get to know your child and your family, keep your child safe, and set clear expectations for everyone. Please complete every part, sign where indicated, and return the packet to the Main Office. Your child’s spot is held once we receive the complete packet. About our programLittle Explorers is a microschool program within Beautiful Minds. We choose to follow childcare best practices and standards wherever we can. Your privacyThe information in this packet is kept confidential. We share it only with staff who need it to care for your child, or as you authorize or the law requires. Packet checklist Check each item as you complete it, then hand it in with your packet. Return with your packetDone Part 1. Enrollment & Family Information Part 2. All About Me Part 3. Health & Allergy Information Part 4. Learning & Development Part 5. Family Agreement & Policies Part 6. Medication Authorization (only if your child needs medication at school) Part 7. Parent Permissions & Releases Copy of any court order or custody papers (if any) Allergy action plan or doctor’s note (if your child has a serious allergy or health condition) PART 1Enrollment & Family Information Please fill in every line that applies to your family. Child Information Child’s full legal name Preferred name or nickname Date of birth Age Start date requested Gender: Female Male Age group: Toddler Preschool Preferred schedule: Monthly Weekly Part-Time (3 days/wk) Days needed: Mon Tue Wed Thu Fri Usual drop-off time Usual pick-up time Language(s) spoken at home Child’s home address (if different from below) Primary Parent/Guardian Full name Relationship to child Cell phone Work phone (optional) Email Home address Employer (optional) Best way to reach me: Text Call Email Brightwheel app Secondary Parent/Guardian (if applicable) Full name Relationship to child Cell phone Work phone (optional) Email Address (if different) Best way to reach me: Text Call Email Brightwheel app Emergency Contacts (Other Than Parents) These adults must be able to reach the school and pick up your child within a reasonable time if we cannot reach you. Contact #1 name Relationship Phone Authorized to pick up? Yes No Contact #2 name Relationship Phone Authorized to pick up? Yes No Authorized Pick-Up List List any other adults allowed to pick up your child. Only the adults listed here may pick up your child. Photo ID may be required. Please tell us in writing before any change. NameRelationshipPhone Custody & Court Orders My child lives with: Both parents Primary parent Other Court order or custody arrangement: None Joint custody Sole custody Other If sole custody, who has legal custody? Is a copy of the court order attached? Yes Not applicable Anyone NOT allowed to pick up my child, or have contact with my child at school NameRelationship (if any)Reason or court order on file? We can only refuse to release a child to a parent or legal guardian when we have a court order on file. If there is a custody or safety concern, please give us a copy of the order. PART 2All About Me Help us get to know your child so we can make the school day comfortable and fun from the very first day. Child’s name Goes by Brothers and sisters (names and ages) and others in the home Favorite toys, books, songs, or activities Favorite foods Foods they dislike Comfort item (blanket, stuffed animal, pacifier) Daily Routines Usual nap time How long they sleep How they fall asleep Meals: Feeds self Needs help Uses a cup Uses a bottle or sippy cup Toileting: Diapers Potty training Fully trained Words your child uses for the bathroom Frequency of accidents (if trained) Communication: Full sentences Some words Gestures or signs Uses a talking device or app Not yet talking Around other children: Loves to play Warms up slowly Prefers adults Plays alone Comfort & Guidance What helps your child calm down when they are upset, tired, or nervous? What tends to upset or scare them? How does your child handle separating from you at drop-off? What helps? What are you most hoping your child gains from Little Explorers? Anything else you would like us to know about your child or family PART 3Health & Allergy Information This helps us keep your child safe and healthy. Please tell us right away if anything changes. Child’s name Doctor & Insurance Primary physician Clinic Phone Dentist (optional) Dentist phone Date of last well-child visit Preferred hospital or urgent care Health insurance provider (optional) Health Information Check all that apply: Asthma Feeding concerns Allergies (food, environmental, medication) Sleep concerns Eczema Behavioral concerns Seizures Hearing or vision concerns Diabetes Heart condition Sensory sensitivities Other Please explain any items you checked (include medicines, triggers, and what staff should do) Any surgeries or hospital stays in the past year? No Yes (explain below) Explain Special equipment or daily care needed at school Allergies No known allergies Yes, please list below AllergenReactionWhat staff should do EpiPen required? Yes No If yes, will an EpiPen be provided and kept on site? Yes No Allergy action plan or doctor’s note attached Food restrictions or preferences (religious, cultural, or medical) Please noteStaff check allergy information before giving any food that did not come from home. Please tell us right away if your child’s allergies or health change. Parent/guardian signature Printed name Date PART 4Learning & Development This helps our teachers plan activities that fit your child. It is confidential and is not used to decide enrollment by itself. Child’s name Previous Care or School My child has been in: No previous care Daycare Preschool Home care Other Name of previous program Dates attended Development Do you have any concerns about your child’s development? Check all that apply: Speech or language Learning Movement or motor skills Hearing or vision Social or emotional Sensory needs Attention or focus No concerns Please explain Services Your Child Receives Speech therapy Early intervention or Birth to Three Occupational therapy IEP or IFSP in place Physical therapy Counseling Other None Provider or agency name Phone or email May we talk with your child’s providers to work together? (see releases in Part 7) Yes No What My Child Can Do Check the skills your child can do now. There are no wrong answers. Every child grows at their own pace. Follows simple directions Recognizes own name Follows two-step directions Holds a crayon Feeds self Takes turns and shares Puts on shoes or coat (with help is fine) Sits for a short story Uses the toilet Counts or sings songs Washes hands Knows some letters or colors Safety Awareness Does your child tend to run away or leave a supervised area? No Sometimes Often Does your child hit, bite, or throw things when upset? No Sometimes Often If you checked “Sometimes” or “Often” for either question, please tell us what triggers it and what works to help. Parent/guardian signature Printed name Date PART 5Family Agreement & Policies Please read each item and initial to show you understand and agree. Child’s name Program Details Program hours Ages served Days open Schedule and plan selected First day of attendance Tuition & Fees ItemAmountNotes Tuition Payment due Payment methods accepted Late payment fee$10 Extended care (over 8 hours in a day)$10Per extra hour Our Policies PolicyInitials Program status. Little Explorers is a microschool program within Beautiful Minds. We follow childcare best practices wherever we can. Illness. Please keep your child home if they have a fever of 100.4°F or higher; vomiting or diarrhea in the last 24 hours; a contagious or suspected contagious illness; an unexplained rash; eye discharge or drainage; or a severe cough, trouble breathing, or unusual sleepiness. If your child becomes ill at school, we will call you for prompt pickup. Your child may return after being fever-free, vomit-free, and diarrhea-free for 24 hours without fever-reducing medicine. Pick-up. Only adults on the authorized pick-up list may pick up your child. Photo ID may be required if we do not recognize the adult. Children who stay longer than 8 hours in a day are subject to extended care charges. Food and supplies. Little Explorers provides lunches and snacks each day, unless parents want to provide their own. Families also provide labeled diapers, wipes, and diaper cream, and a spare change of clothes. Nap time is from 12:00 to 1:30 PM. Allergies and food. Staff check allergy information before giving any food that did not come from home. Guidance. We guide behavior with redirection, modeling, and positive strategies. We do not use time-out or isolation as discipline. A calm space may be offered as a voluntary tool, never as a consequence. Communication. We share daily updates (sleep, diapering, and food) and photos through Brightwheel. Please keep your contact information current and tell us right away about any change. Injuries and incidents. If your child is injured or involved in a significant incident, we will give first aid, notify you, complete an incident report, and may ask for your signature at pick-up. For emergencies we call 911 and contact you right away. Medication. We give medication only with a signed authorization form, the original labeled container, and clear dosing instructions. We record every dose. Child safety reporting. All Little Explorers staff report any reasonable suspicion of child abuse or neglect as South Dakota law requires. Withdrawal and schedule changes. Please give 14 days of written notice to withdraw or change your child’s schedule. Ending enrollment. Little Explorers may end enrollment for unpaid tuition, safety concerns, or if we cannot safely meet your child’s needs. We will talk with you first whenever possible. I have read and understand the policies above and agree to the tuition and fees listed in this agreement. I understand that Little Explorers may update these policies, and I will receive written notice of changes. Parent/guardian signature Printed name Date Second parent/guardian signature (if applicable) Printed name Date Little Explorers representative Printed name Date PART 6Medication Authorization Complete one form for each medication. Only needed if your child requires medication at school. Child’s name Date of birth Medication name Prescribing provider (if any) Form: Liquid Tablet Inhaler Cream Other Reason for medication Dosage How often Time(s) to give Start date End date Last dose given at home (date & time) Storage needs (for example, refrigerate) Possible side effects to watch for Special instructions Medication must be✓ In its original packaging ✓ Labeled with your child’s name ✓ Accompanied by clear dosing instructions from you (and the doctor, for prescriptions) Parent Agreement I authorize Beautiful Minds Little Explorers staff to give the medication listed above to my child. I understand staff will record each dose and tell me about any concerns. I understand staff cannot give medication without this authorization. Parent/guardian signature Printed name Date PART 7Parent Permissions & Releases Photos, outings, sunscreen, first aid, emergency care, records release, and assumption of risk. Child’s name Photo & Video Permission Yes, I allow photos and videos for internal updates (sent only to me and my family). Yes, I allow use for marketing and social media. (If selected, my child’s face will always be blurred in any public post.) No, I do NOT allow any photos or videos. Walking Trips & Outdoor Outings Yes, my child may take part in supervised walking trips near the school. No, my child may not take part. Field Trips & Transportation Yes, I allow my child to go on off-site field trips. I will receive a notice and details before each trip. No, I do not allow off-site field trips. Sunscreen & Water Play I will provide labeled sunscreen for my child. The school may apply my child’s sunscreen as directed. Water and sensory play (sprinklers, water tables) is okay: Yes No First Aid I allow staff to give basic first aid (cleaning a scrape, bandage, cold pack): Yes No Emergency Medical Treatment In an emergency, I authorize Beautiful Minds Little Explorers staff to call 911 and/or arrange emergency medical care for my child. I understand I am responsible for any medical expenses. Yes No Release of Information I allow Little Explorers to share information about my child with, and get information from, the people I list below, so we can support my child together. Yes, I give permission No, I do not Person or agencyRelationshipPhone or email Assumption of Risk I understand that normal school activities, including active play, carry an inherent risk of minor injury such as bumps, scrapes, and falls. I understand that Beautiful Minds Little Explorers will provide reasonable supervision and care, and I accept this inherent risk as part of my child’s enrollment. Parent/guardian signature Printed name Date For Office Use Only Packet complete and signed Photo & release permissions signed Emergency contacts confirmed Tuition and fees agreement signed Registration fee received Brightwheel invite sent Custody or court order on file Allergy or health plan on file Date received Received by Start date confirmed Submit Online I agree that typing my name on this form is the same as signing it by hand, and that the information I gave is true and complete. Type your full name to sign Today’s date Submit Enrollment Form After you submit, the Little Explorers office will contact you to confirm your child’s start date. Questions? Call (605) 608-0833.
