Fillable YAM 2019-2020 Enrollment Packet For Tribal Employees%27 Children Final (Chitimacha Tribe of Louisiana)

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YAM 2019-2020 Enrollment Packet For Tribal Employees%27 Children Final (Chitimacha Tribe of Louisiana)

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The YAM 2019-2020 Enrollment Packet For Tribal Employees%27 Children Final (Chitimacha Tribe of Louisiana) form is 17 pages long and contains:

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BROWSE CHITIMACHA TRIBE OF LOUISIANA (LA) FORMS

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2
ITEMS REQUIRED TO ENROLL/RE-ENROLL YOUR CHILD
___ $50 registration fee
___ Completed Enrollment Packet
___ Copy of child’s birth certificate (First-Time Students Only)
___ Copy of Social Security card (First-Time Students Only)
___ Proof of Legal Guardianship, if applicable
___ Immunization Record
___ All supplies listed for your child’s room
3
Admission Date_________________________
Withdrawal Date_______________________
Yaamahana/Chitimacha Child Development Center
General Information Master Form
Child’s Name (First)_________________(MI)__________(Last)__________________________
Birth Date ________________________________________________________Sex___________
Mother
Father
Name
Address- P.O. Box
Address-Street
Employer
Home Phone #
Work Phone #
Cell Phone #
Email Address
Person with whom the child lives: ________________________________________________________
Days child will attend center:
_____2 Days (circle the 2 days the child will attend each week - M T W T F )
_____3 Days (circle the 3 days the child will attend each week – M T W T F )
_____5 Days _____Half Day (Morning only 7:00-12:00)
_____Full Day _____After School Care (Afternoon only 2:30-5:30)
To request an application for the Louisiana Department of Education’s Child Care Assistance Program
(CCAP) call 1-877-453-2721 or go to LDEccap@la.gov.
Select the best way for your child’s provider to communicate information to you about your child:
___ Written notices ___ Email ___ Telephone
Yaamahana will not bear responsibility for anything that may happen as a result of false or misleading
information given at the time of enrollment. Parents are responsible for updating all enrollment
information.
Parent/Guardian Signature _______________________________________Date:____________________
Parent/Guardian Signature _______________________________________Date:____________________
4
Yaamahana/Chitimacha Child Development Center
Emergency Contact & Release Information Form
Child’s Name: ________________________________________________
Mother
Father
Name
Home Phone #
Work Phone #
Cell Phone #
Child’s Doctor:_____________________________________ Doctor’s Phone #:___________________
Child’s Dentist:_____________________________________ Dentist’s Phone #:__________________
Individuals to contact in case of an emergency:
____________________________________________ Phone #:______________________________
____________________________________________ Phone #:______________________________
____________________________________________ Phone #:______________________________
____________________________________________ Phone #:______________________________
Does your child have any food allergies? Yes No
Does your child have any other allergies? Yes No
Does your child have any dietary restrictions? Yes No
Please explain any “yes” answer here:______________________________________________________
______________________________________________________________
***************************************************************
My child has permission to be released to the following individuals in addition to emergency contact
persons listed above. (Please notify these individuals that they may be asked to show proof of identity.
NAME
RELATIONSHIP
I authorize the facility to secure emergency medical treatment for my child.
Parent/Guardian Signature _________________________________Date:__________________________
Parent/Guardian Signature _________________________________Date:__________________________
5
Yaamahana/Chitimacha Child Development Center
Payment and Attendance Schedule Agreement Form
____________________________________
Child’s Name
I understand that TUITION PAYMENTS ARE DUE IN ADVANCE OF SERVICES. For example:
The child is enrolled for 3 days a week (T, W, TH) and the parent selected a 2 weeks tuition payment
schedule. If the child starts on a Wednesday, tuition is due on that day for that week (W & TH) and
by the close of business on Tuesday for every two weeks thereafter.
I understand that cash will be accepted at the center. Please make all tuition payments including cash
payments at Yaamahana. Please write checks, cashier’s checks, or money orders to Chitimacha Tribe
of Louisiana. When making a payment in cash, exact change is requested. A $25.00 fee will be
assessed to all NSF checks. If two NSF checks are processed within a year checks will no longer be
accepted.
I understand that once tuition payments are 5 business days (1 week) past due, a $5.00 late fee per
family will be assessed. The late fee will continue to be assessed weekly to all accounts with a past due
balance.
I understand that once tuition payments are 5 business days (1 week) past due, the Director will send a
letter stating that a payment must be made by the 10
th
day or my child will no longer be able to attend
Yaamahana. I understand that if I choose to re-enroll my child, all tuition fees, late fees and a new
registration fee shall be required before the child is accepted. Once I withdraw my child, I have 30
days to pay the balance before my account is turned over to the Finance Department.
I select the following tuition payment schedule. Tuition payments will not be refunded.
Please check one:
_____ 1 Week _____ 2 Weeks _____ 4 Weeks
Days child will attend center:
_____2 Days (circle the 2 days the child will attend each week – M T W T F)
_____3 Days (circle the 3 days the child will attend each week – M T W T F)
_____5 Days (circle the 3 days the child will attend each week – M T W T F)
_____ Half Day (Morning Only 7:00-12:00)
_____Full Day _____After School Care (Afternoon only 2:30-5:30)
Parent/Guardian Signature:_______________________________________Date:____________________
Parent/Guardian Signature:_______________________________________Date:____________________
6
Yaamahana/Chitimacha Child Development Center
Photographing, Videotaping, Audiotaping, and Observation
Release Form
I understand that Yaamahana has video cameras and video equipment that records the daily
activities throughout the facility. These video recordings are conducted for the protection of
the children and staff.
I understand that at various times throughout the year, the staff of Yaamahana will be taking
digital images, photographs, videotapes, and/or audiotapes of the children for educational
purposes (e.g. presentations to train Yaamahana staff) and decoration purposes (e.g. posting
pictures on bulletin boards, in cubbies, etc.).
I understand that parents are also allowed to come into the center and observe, photograph,
videotape, and/or audiotape children.
I, the undersigned, do hereby grant or deny permission to Yaamahana to use the image of my
child, _________________________, as marked by my selection(s) below. Such use
includes the display, distribution, publication, transmission, or otherwise use of photographs,
images, and/or video taken of my child along with his/her first and last name for use in
materials that include, but may not be limited to, printed materials such as brochures and
newsletters, videos, and digital images such as those on the Chitimacha Tribal Web site and
the Franklin Banner Tribune. No child will be observed, video-taped, recorded, or
photographed without the supervision of a child care provider and the authorization of
Yaamahana’s Director or Director Designee.
___ Deny permission to use my child’s image at all
___ Grant permission to use my child’s image in the following ways:
___ Limited usage: I want my child’s image and first and last name used on
printed materials only (no digital or video use).
___ Unrestricted usage: I give unrestricted permission for my child’s image and
first and last name to be used in print, video, and digital media. I agree that
these images may be used by Chitimacha Tribe of Louisiana for a variety of
purposes and that these images may be used without further notifying me. I do
understand that the child’s last name will not be used in conjunction with any
video or digital images.
Parent/Guardian Signature:___________________________Date:___________________
Parent/Guardian Signature:___________________________Date:___________________
7
Yaamahana/Chitimacha Child Development Center
Non-Vehicular Excursion Authorization
My child, _____________________________, has my permission to
participate in walks, stroller rides, and wagon rides on the reservation. Non-
vehicular excursions shall include nature walks/rides, walks/rides to the
Chitimacha Sports Complex, Chitimacha Tribal School, Rivercane, Chitimacha
Recreation Department, Chitimacha Fire Station, and the Chitimacha Police
Station. The children will be accompanied by at least two Yaamahana staff
whenever participating in a non-vehicular excursion. At least one Yaamahana
employee accompanying the children must be currently trained in CPR/First
Aid.
Parent/Guardian Signature:___________________________Date:___________________
Parent/Guardian Signature:___________________________Date:___________________
8
Yaamahana/Chitimacha Child Development Center
Application of Topical Products Authorization Form
Like all medications, topical products must be prescribed or recommended by a
licensed health care provider (Physician – Nurse Practitioner). When trying a new
topical product, the first application should be applied at home and the parent should
observe the child for any adverse reactions.
I give permission for the Yaamahana staff to apply the following topical products to my
child with a one-time authorization.
Child’s Name: ____________________________________________________________
Yes No
( ) ( ) Sunscreen
( ) ( ) Insect Repellant (lotion or alcohol-based repellants are recommended)
( ) ( ) Diaper Rash Ointment
This one time authorization will remain in effect until a new authorization is signed.
Parent/Guardian Signature:_______________________________Date:_______________
Parent/Guardian Signature:_______________________________Date:_______________
9
Yaamahana/Chitimacha Child Development Center
Water Activities Release Form
I understand that children two years of age and above can participate in water play activities
in which there is no standing water, and includes but is not limited to the use of fountains,
sprinklers, and water tables. Children under three years of age, shall not engage in water
activities in wading or swimming pools due to the risk of fecal-oral contamination and
disease.
I understand that children three years of age and above, completely toilet-trained, can also
participate in water activities in wading or swimming pools. I understand that water
activities for children three years of age and above may also include trips to the Chitimacha
pool at the Recreation Department on the reservation where an appropriate number of trained
life guards and Yaamahana staff will be on duty.
My child, ______________________, has permission to participate in any of the above
supervised age appropriate water activities while attending Yaamahana. I understand the
center will take precautions in providing for the safety of my child.
Parent/Guardian Signature:______________________________Date:________________
Parent/Guardian Signature:______________________________Date:________________
10
Yaamahana/Chitimacha Child Development Center
Additional Information About My Child
What would you like us to know about your child that will help us in providing quality
care?
Parent/Guardian Signature: ___________________________Date:___________________
Parent/Guardian Signature: ___________________________Date:___________________
11
Yaamahana
Chitimacha Child Development Center
Parental Agreement
_____________________________
Child’s Name
Dear Parents,
Please read and sign this agreement:
I have been given a copy of the Chitimacha Child Development Center Family Handbook
which contains program and policy information. I hereby agree to comply with the rules and
regulations regarding fees, attendance, health, clothing, and other items specified in the
Family Handbook.
I agree to keep all enrollment information updated (e.g. household income, telephone
numbers, address, designated adults allowed to pick up child, immunization records, etc.).
I further agree to notify the center of any change in my financial situation or changes which
would affect my ability to meet my financial obligation within 7 days.
Parent/Guardian Signature: ___________________________Date:___________________
Parent/Guardian Signature: ___________________________Date:___________________
12
Yaamahana
Chitimacha Child Development Center
Weekly Tuition Rates
Full Day
$110.00/Week
Half Day
$55.00/Week
3 Days / Week
$66.00/Week
2 Days / Week
$44.00/Week
After School Care
$55.00/Week
• $50 yearly registration fee due at time of enrollment/re-enrollment
• $30 registration fee for pre-k Summer Care program only
• Sibling discount will be $2.00 per day.
• Yaamahana employee discount will be $2.00 per day per employee.
• Prices are subject to change depending on availability of funds.
Diaper & Wipes Rates
5 Days
$7.00 / Week
4 Days
$6.00 / Week
3 Days
$5.00 / Week
2 Days
$4.00 / Week
1 Day
$3.00 / Week
13
Yaamahana
Chitimacha Child Development Center
SUPPLY LIST FOR QAKUN ROOM (Infants)
Please label all items with your child’s initials.
__ Unopened Can of Formula as needed
___ Enough clean, prepared bottles with caps/covers to last the day
___ Unopened Containers of baby food as needed
___ Extra pacifier to leave at center if needed
___ 2 complete changes of clothes
___ Shoes and socks each day
___ 1 box of tissues per month
___ Family poster
-------------------------------------------------------------------------------------------------------------
Yaamahana
Chitimacha Child Development Center
SUPPLY LIST FOR KEESGI ROOM (1-Year-Olds)
Please label all items with your child’s initials.
___ Extra pacifier to leave at center if needed
___ 2 complete changes of clothes including socks
___ Child size toothbrush
___ Toothpaste as needed
___ Crib sheet and blanket for naptime
___ 1 box of tissues per month
___ Family poster
14
Yaamahana
Chitimacha Child Development Center
SUPPLY LIST FOR NEXJUWA ROOM (2-Year-Olds)
Please label all items with your child’s initials.
___ 2 complete changes of clothes including underwear and socks
___ Child size toothbrush
___ Toothpaste as needed
___ Crib sheet and blanket for naptime
___ 1 box of tissues per month
___ Family poster
-------------------------------------------------------------------------------------------------------------
Yaamahana
Chitimacha Child Development Center
SUPPLY LIST FOR KAMCIN ROOM (3-Year-Olds)
Please label all items with your child’s initials.
___ 2 complete changes of clothes including underwear and socks
___ Child size toothbrush
___ Toothpaste as needed
___ Crib sheet and blanket for naptime
___ 1 box of tissues per month
___ Family poster
15
Yaamahana
Chitimacha Child Development Center
SUPPLY LIST FOR COOTA ROOM (Pre-k)
Please label all items with your child’s initials.
___ 2 complete changes of clothes including underwear and socks
___ Child size toothbrush (Summer Care)
___ Toothpaste as needed (Summer Care)
___ Crib sheet and blanket for naptime (Summer Care)
___ 4 box of tissues per month
___ Family poster
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YAM 2019-2020 Enrollment Packet For Tribal Employees%27 Children Final (Chitimacha Tribe of Louisiana)

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Completed 20 July 2020

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