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718 Hogestown Road Mechanicsburg, PA 17050 ● 717.790.0770 ● Fax 717.795.1050
ceo@dumplinggang.org ● www.dumplinggang.org ● Apple Dumpling Group, Inc.
Parent Contract - Mechanicsburg, PA
Application for Admission
Mother’s
– 4 Digit Security Code: ________ Father’s – 4 Digit Security Code: ________Child’s Last Name
: ______________________ First Name: _________________________ DOB: _______________ Start Date: ___________________Address: ________________________________ City: _______________________________ Zip Code: _____________ Program: _____________________
Parent Information
Mother’s Last Name
: _____________________ First Name: __________________________ PA Lic # _____________ SSI # _______________________Address: ________________________________ City: _______________________________ Zip Code: ____________ Phone: ______________________
Work Name: ____________________________ Address: ____________________________ City: _________________ Zip Code: ___________________
Work Phone: ____________________________ Cellular Phone: _______________________ E-mail: _______________________________________________
Father’s Last Name
: ______________________ First Name: __________________________ PA Lic # _____________ SSI # _______________________Address: ________________________________ City: _______________________________ Zip Code: ____________ Phone: ______________________
Work Name: ____________________________ Address: ____________________________ City: _________________ Zip Code: ___________________
Work Phone: ____________________________ Cellular Phone: _______________________ E-mail: _______________________________________________
Financial Policies (ADG accepts VISA, MasterCard & Discover)
[ ]
Non-Refundable Registration Fee: ___________________ [ ] Paid [ ] Coupon [ ] Non-Refundable Program Fee: _________________ Charged Annually[ ]
I have received a copy of Apple Dumpling Gang’s Parent Handbook & Policy Manual in accordance with DPW 55 PA Code Chapters 3270.121, 3280.121, 3290.121.[ ]
Fee for Services: ________________ Will be paid every ___________________ (week, 2 weeks, monthly, etc.) On each ________________ (day of the week).______
(Initial) ADG financial policies and your commitment – we require that each family fills out an application for Tuition Express, however, active participation will be by your request. This makes it possible for us not to require a deposit equal to one week’s tuition. This is a very convenient option to ensure that your account is always kept current. If you are interested in taking advantage of this, simply let the director know and your application will be activated immediately._____
(Initial) Please note, that any family who neglects to fulfill their commitment with our center in regards to regular, on time payments or withdrawal notification, will be automatically subjected to activation of Tuition Express. Automatic enrollment takes place when any of the following situations occur:1.
Late payment of tuition: We bill weekly and tuition is due the first day your child attends each week served (or as per mutual agreement). Payments not received on time will be charged $25 per week excluding special circumstances pre-discussed with the Executive Director. Failure to meet your financial commitment will result in the automatic activation of this program.2.
NSF: Any returned check will result in a $35.00 NSF fee and automatic activation.3.
Withdrawal without notification: We require two weeks written notification upon decision to withdraw your child from our program. Failure to provide proper notification will result in the automatic activation of this program for the purpose of collecting our two weeks payment from your account.We at ADG provide an excellent program and care for the children we serve. To continue providing this level of quality service, it is our expectation that parents be responsible by maintaining their financial commitment. ADG operates on a
zero tolerance policy when it comes to the financial obligations of its families. Failure to meet your commitments will result in whatever action ADG deems necessary to collect outstanding balances. In the event your account becomes delinquent any and all fees associated with the collection of your account will be added to your account balance.______
(Initial) I acknowledge that this agreement is for twelve months, during which ADG will allow me the equivalent of two weeks of my child’s program in personal leave time (see Parent Handbook for more details). Once these days have been used, I understand and agree to pay for any and all additional days that my child is absent from the program, which may include holidays, school breaks, and any weather related closings. Should I choose to opt out or withdraw my child before the end of this agreement period and I have used more days than earned, I also agree to allow ADG to bill my account any outstanding balance owed. Personal Leave Time must be used within the current 12 month agreement period and cannot be banked or carried from one year to another. I also acknowledge that I am aware that ADG has a policy whereby all parents are required to give the center two (2) weeks written notice prior to withdrawing their child.______ (Initial)
I acknowledge and understand that a charge of $50.00 per half hour or any part thereof will be charged for any drop-offs before 6:30 AM or pick-ups after 6:00 PM. PRESCHOOL FAMILIES ONLY: I further acknowledge that any part-time child that exceeds the posted time limits will be automatically charged the full day rate based upon their program. Please note that the Centers clock will be used as the official clock in all disputes concerning this policy.______ (Initial)
I acknowledge and agree to pay half of my regular tuition rate for all published holidays and or in-service days that fall on one of my child’s regularly scheduled attendance days as outlined in the ADG Parent Handbook. It is one way we as parents, along with the administration of ADG, can show our appreciation and support to those who put so much into the care and nurturing of our children.If you have any questions in regards to the financial commitment agreement, please contact the director before signing this form.
Food Services Policies
Meals Served:
[ ] Morning Snack (around 9:15 a.m.) [ ] Lunch (around noon) [ ] Afternoon Snack (around 2:45 p.m.)Menus are made available at the beginning of each month and are posted on our website.
PARENTS MUST PROVIDE ANY SPECIAL DIETARY NEEDS. Under some circumstances, parents will be required to provide their child’s lunch. Our Food Services program meets all the standards and guidelines established by the United States Department of Agriculture. (www.mypyramind.gov) Parents always have to option to pack a bag lunch for their child in the event that the published lunch for the day is not their family choice.______ (Initial)
ADG’s requires that either you have your child in the facility no later then 9:15 a.m. or you must call the center to let us know that your child will be here in time for lunch (Toddler’s 11:20 a.m., Preschool 12:00 p.m.). Failure to do so will require you to furnish a bag lunch for that day. This count is crucial to the kitchen in order to make sure that the adequate amount of food is prepared without waste.ADG serves 100% Juice with our AM snack, Milk with lunch, and Water at our PM snack times.
Arrival & Departure Times (In helping us maintain a safe and proper teacher/child ratio we ask that you help us by estimating your drop-off and pick-up times.)
__________ Est. Arrival Time __________ Est. Pick-up Time
| Monday | Tuesday | Wednesday | Thursday | Friday |
| -- | -- | -- | -- | -- |
This Center operates MONDAY through FRIDAY; 6:30 a.m. to 6:00 p.m. Please refer to your Parent Handbook and/or the current Rate Sheet for a complete list of holidays the Center will be observing this year
Discipline and Termination from the Program
Our staff is dedicated to the philosophy that "children can be responsible for actions and decisions of their choosing if the environment is conducive to a loving and gentle approach of self-governing." In other words, we help children to make good choices and learn self-control by building a framework allowing them to work through problems constructively. We model and encourage appropriate behavior, use re-direction and discuss issues. Time-out is used as a last resort.
Should a child’s behavior put his or another’s health or safety at risk; a director-teacher-family conference will be called to discuss alternative methods to remedy the behavior. Apple Dumpling Gang reserves the right to terminate any child from the center who cannot be adequately served due to behavioral issues. All meetings and agreements shall be documented in writing and every avenue will be pursued prior to termination of services.
Please note: the policy of this center is to meet the needs of each individual child to the best of our ability; individual needs are considered but the class as a whole must be the primary consideration. Should your child require care beyond what we are able to give, an appropriate notice will be given the family to find alternate care. It is not our intention to use this policy except in absolute necessity. We will always seek for the best care for your child even when it is not with us. This policy is at the complete discretion of the administration.
Non-Discrimination Policy
It is the policy of Apple Dumpling Group, Inc. and Apple Dumpling Gang to recruit and process the applications of children wishing to be a part of our center without regard to race, color, national origin, sex, age, or religion. This program does not and will not discriminate. Admissions, the provision of services, and referrals of clients shall be made without regard to race, color, religious creed, disability, ancestry, national origin (including limited English proficiency), age, or sex.
Other Items of Interest
______ (Initial)
I/We do give permission for my child to be photographed and/or video taped and the photographs/video tapes to be displayed on the center’s website and as part of the center’s on-going advertising campaign. I/We understand that such pictures are the complete property of ADG.I/We understand that pictures are taken of all the children and are used for various projects and activities within the classrooms. I/We understand that ADG never associates a child’s name with their picture when it is used or posted either to its website or part of an advertising campaign.
______ (Initial Required)
I/We understand that infant formula; foods not a part of our regular program, diapers and diaper wipes are the responsibility of the parent. Should the need arise where the center has to provide such things the parents will be charged for the items. Parents are also responsible to provide a sheet and blanket for rest times and any special sleep aid (pillow, toy, etc.) necessary for your child’s comfort. A change of seasonal clothing is to be kept at the center at all times in case of an emergency. Please label all of these items with your child’s first and last name. Parents are responsible for the weekly laundering of sheets and blankets.Parents are
required to carry medical and accident insurance on the enrolled child. Parents are responsible for transportation to and from the child care facility.Field trips for students will be conducted at various times during the year. Permission to participate will be obtained from the Parent Consent and Emergency Information Form (this consent is not a blanket consent) and from the Field Trip Sign-Up Sheet for each trip. In some instances, a nominal fee may be charged for certain field trips.
Emergency medical services will be provided as indicated by the Plan for Emergency Medical Treatment. Medication will be dispensed only with a physician’s current instructions and written consent from the child’s parent by completing and signing the center’s Medication Log Sheet (period of time must be specified on instructions). The Medication Log Sheet must be completed each day the child is required to receive medication.
______ (Initial Required) Parents agree that they will comply with the center’s Child Illness Policy as provided prior to enrollment. Staff will notify parents to pick-up their child in case of illness.
______ (Initial)
I/We agree to update the Parental Consent/Emergency Contact form information whenever changes occur or every 6 months at a minimum. (DPW 55 PA Code Chapters 3270.124, 3280.124, 3290.124)Prolonged Leaves of Absence
: Any leave from the center, after exhausting any and all earned personal days, will incur the same weekly charge as per your Parent Contract. The maximum leave of absence allowed in any 12 month period will be 4 weeks. Upon where the Director at his discretion may remove your child from the enrollment and fill that vacancy.Parent Contract Changes
: Will be limited to once per calendar year and subject to space availability. We will, however, do everything within our ability to accommodate your needs.ADG is completely computerized in the operation of its center; meaning that each adult who has been authorized by you the parent must be willing to supply us with their own uniquely individualized 4 digit pin allowing them to either sign in/out your child. In addition to this pin each adult will be asked either to allow us to photograph them or they must be prepared to produce some form of photo ID. All of this is provided in an effort to make sure that we are only releasing your child to those who you have designated.
Please understand that it is the firm policy of this organization that we will only release a child to those who have been parent-authorized or those who can show they have legal rights such as proof of custody from a recognized authority. Also it is the policy of ADG that an adult must physically come into the center and either check in or out the child.
______ (Initial)
I/We understand that the Center reserves the right to terminate this Contract if the parent/guardian does not meet the above outlined terms of this agreement.______ (Initial)
I/We consent to all terms of this Parent Contract and have been given a signed and dated copy of this agreement.______ (Initial)
I/We further acknowledge and have read all the information outlined within this agreement, the Parent Handbook and the current rate sheet. I/We also understand that this Contract is subject to change from time to time as needs arise or rates change and all that is necessary for this to occur is for Apple Dumpling Group, Inc. or Apple Dumpling Gang to adopt and publish and this policy in writing.ADG provides an up-dated Parent Handbook to all families once a year during the month of July or upon enrollment. However, a current updated version is always available on our website for your review or download.
Director ___________________________________ Date __________ Parent: ____________________________________ Date: _________
Parent: ____________________________________ Date: _________
Revised June 2008