55 PA CODE CHAPTERS 3270.124(a)(b), 3270.181 & 182, 3280.124(a)(b), 3280.181 & 182, 3290.124(a)(b), 3290.181 & 182
PARENTS SIGNATURE IS REQUIRED FOR EACH ITEM BELOW TO INDICATE PARENTAL CONSENT
55 PA CODE CHAPTERS 3270.123&.18l(C); 3280.123&0l81 (c); 3290.123&.18I (c)
$10-5:31pm-5:36pm- $1.00 a min-After 5:36pm PKC and HS - $25 at 3:01 pm
I, the parent/guardian;
- Received complete written program information at the time of enrollment (S 3270.121, 3280.121 ,3290.121)
- Agree to update the emergency contact/ parental consent for information whenever changes occur or every 6 months at a minimum. (S 3270.124, 3280.124, 3290.124)
PLEASE PUT YOUR INITIALS NEXT TO WHAT IS APPLICABLE FOR YOUR CHILD:
Your child's growth and development is measured with developmental assessments. If your child currently has an IEP/IFSP, it would be beneficial to share a copy of this plan with us so we can work together to ensure that the guidelines are put into practice. You do not have to provide this information if you do not wish to do so.
Occasionally the Center staff or approved visitors take pictures of or videotape the children. You can be sure that we take precaution for our children and these pictures (still or moving) maybe used to publicize and promote Center activities or events. Pictures may appear in local newspapers, center brochures, or on television. No additional notice may be given of picture-taking sessions.
LPV TRIP SHIRT
We also take the children out on trips to local parks or cites where there may be groups of people. For such occasions, at the time of registration, children are given a t-shirt that has our school logo and telephone number on it.
If you would like for your child's records to be transferred, we would need 72 hours’ notice. We would also need a written letter or form stating which records, why you want them to be transferred, and where you would like them to go.
|Wears Diapers or Pull-ups
|Wears Glasses or has a lazy eye, crossed eye, wandering eye or other eye condition
|Has ear tubes, hearing loss, wears a hearing aid, has a history of ear infections or other ear conditions
|Has excessive colds, sore throats, coughing episodes, snores loudly
|Has a history of asthma or bronchitis
|Has a heart murmur, a resolved heart murmur, rheumatic fever or other heart conditions
|Has a history of anemia, sickle cell disease, elevated lead level
|Has G6PD, hemophilia, or other blood conditions
|Has an umbilical or inguinal hernia
|Has reflux, stomach pain, diarrhea, constipation, trouble urinating, urinary tract infection or kidney disease
|Has a feeding tube
|Has diabetes (If yes, please indicate Type I or Type Il)
|Has rashes, eczema, hives, boils
|Has neuropathy, muscle tics, spina bifida, muscular dystrophy, cerebral palsy
|Wears leg braces, uses a cane, walker, or wheelchair
|Has/had polio, chicken pox, measles, mumps, scarlet fever, whooping cough
|Experiences car sickness
CHILD PICK-UP AUTHORIZATION
Note: Parents and guardians should designate themselves and designated custodians.
Friends, neighbors and other relatives may also be designated.
PLEASE PRINT CLEARLY
Emergency Operation Plan
To the Parent/Guardian
This letter is to assure you of our concern for the safety and welfare of children attending Little Peoples Village. Our Emergency Operations Plan provides for response to all types of emergencies. Depending on the circumstance of the emergency, we will use one of the following protective actions:
- Immediate Evacuation Students are evacuated to a safe area on the grounds of the facility in the event of a fire etc.
- In-place Sheltering Sudden occurrences, weather or hazardous materials related, may dictate that taking cover inside the building is the best immediate response.
- Evacuation Total evacuation of the facility may become necessary if there is a danger in the area. In this case, children will be taken to Relocation Facility at Good Shepard Church 6439 N 65' St Phila., Pa 19151.
- Modified Operation May include cancellation/postponement or rescheduling of normal activities. These actions are normally taken in case of a winter storm or building problems that make it unsafe for students (such as utility disruptions) but may be necessary in a variety of situations.
Please listen to Channel 6 ABC News for announcements relating any of the emergency actions listed above.
We ask that you not call during the emergency. This will keep the main line telephone free to make emergency calls and relay information. We will call you to let you know that we've taken one of these protective actions. We will also call you when we've resolved the situation and it's safe for you to pick up your child.
The facility director may provide an alternate phone number (i.e. cell phone number, etc.) to call in an emergency event. All center calls will be transferred to the location of Good Shepard Church.
The form designating persons to pick up your child is included with this letter for you to complete and have returned to the day care center no later than one week. This form will be used every time your child is released. Please ensure that only those persons you list on the form attempt to pick up your child.
I specifically urge you not to attempt to make different arrangements during an emergency. This will only create additional confusion and divert staff from their assigned emergency duties.
In order to assure the safety of your children and our staff, I ask your understanding and cooperation. Should you
have additional questions regarding our emergency operating procedures contact the Director at LPV 215-474-3011.
CHILD HEALTH REPORT
(55 PA CODE §§3270.131, 3280.131 AND 3290.131)
DO NOT OMIT ANY INFORMATION
This form may be updated by a health professional. Initial and date any new data. The child care facility needs a copy of the form.
NOTE BELOW IF THE RESULTS OF VISION, HEARING OR LEAD SCREENINGS WERE ABNORMAL. IF THE SCREENING WAS ABNORMAL, PROVIDE THE DATE THE SCREENING WAS COMPLETED AND INFORMATION ABOUT REFERRALS, IMPLICATIONS OR ACTIONS RECOMMENDED FOR THE CHILD CARE FACILITY.
RECORD DATES OF IMMUNIZATIONS BELOW OR ATTACH A PHOTOCOPY OF THE CHILD’S IMMUNIZATION RECORD
COVID-l9 PUBLIC HEALTH EMERGENCY SPECIAL PROGRAM ATTENDANCE ACKNOWLEDGMENT AND DISCLOSURE
FAMILY/CHILD VERSION: This should be initialed and signed by BOTH parents.
Please read and initial each statement below.
- • Fever of 100.4 degrees Fahrenheit or higher
- • Dry cough
- • Shortness of Breath
- • Chills
- • Loss of taste or smell
- • Sore Throat
- • Muscle aches
While we understand that many of these symptoms can also be related to non-COVID-19 related issues we must proceed with an abundance of caution during this Public Health Emergency. These symptoms typically appear 2-7 days after being infected so please take them seriously. Your child will need to be symptom free without any medications for 72 hours before returning to the facility.
Due to restrictions still in place, we will reopen at 75% capacity in each room. When instructed to and all safe measures are taken, we will open with full operation hours. It's impossible to have the same staff care for the same kids throughout the day without mixing up children and teachers from other classes so changes were made for everyone's safety.
New Temporary hours
We will be reopening Monday -Friday 7:30am-5:30pm. With only serving children no longer than 9 hours a day.
Same staff and same classroom
To help minimize interactions throughout the building, we are having all classrooms open throughout the day
from open to close. This will help isolate any spread if a child or staff get sick. We will not be mixing the children or staff in different classrooms at any time. Same staff with same kids! Due to this guideline. We had to lower our hours to accomplish this goal. We will be open from 7:30-5:30pm and children can not exceed a 9hr period in a day. We also put a third teacher in each classroom to make sure all hours are covered, with same teachers, for the duration of the day.
We wil6 lower our enrollment to we feel it is safe per CDC guidelines to go to regular capacity. By limited capacity, we hope this will lower the chance of covid spreading.
Drop off/pick up and labeled Waiting Spots
Designated drop off/pick up for children will be in rear entrance yard. This will allow adequate space for social distancing. We will have markings 6 feet apart near entrances so families know where to stand safely from one another.
Only Students and Staff Allowed Inside
Each person who enters a facility increases the chances of COVID-19 transmission, so it is a good idea to keep families outside and not allow any visitors.
Assign the same staff members the responsibility of greeting families and walking each child to their classroom.
Health Screening Questionnaire
Before a child is allowed inside, parents answer a questionnaire to ensure they do not have any signs of COVID-19. Here is a sample questionnaire you can use:
Do you or your child or any member of your household have any of the following symptoms?
Fever (37.8C 100.4F Or Higher)
Shortness of Breath
Loss of Taste or Smell
Nausea/Vomiting, Diarrhea, Abdominal Pain
Runny Nose, or Nasal Congestion (In the absence of underlying reasons such as Seasonal Allergies, Nasal Drip, Etc.) Unexplained Fatigue/Malaise/Myalgia
Conjunctivitis (Pink Eye)
Lethargy/Difficulty Feeding in Infants
Have you had contact with anyone with acute respiratory illness or who travelled outside of (country) in the last
Have you had close contact with someone who has been diagnosed with COVID-19?
If you answered YES to any of these, DO NOT enter. Your child cannot be permitted to enter to ensure the safety of everyone. Contact your health care provider.
Check each staff and child's temperature using an infrared contactless forehead thermometer to ensure they do not have a fever before entering the building. This will be done at least twice a day to ensure temperature doesn't go up during the day.
Ensure that every adult is wearing a face mask. Children under 3 years old should not wear face masks. There are mixed opinions on whether older children should wear masks and so unless legally required it is up to your discretion whether children should be required to wear them.
Our staff member will check in/out children in for attendance on our childcare app daily.
Hand sanitizing station at the entrance of the building for all staff, parents and children to use before interacting with one another. Frequently washing hands with soap and water.
Indoor and Outdoor Play
Gross Motor activities are still included in your child's daily schedule but have been modified. Toddlers will only use the indoor play space which will be sanitized between each classroom use. Preschoolers and School Age children will use the outdoor play yard and equipment which will also be sanitized after each class use.
We will only take scheduled meetings with the directors, teachers and management. You must contact the front desk to schedule a meeting if necessary, to discuss any concerns. We want to ensure your safety as well as ours.
Outside Food (12 months and up) and Personal Items
Little Peoples Village has had a NO OUTSIDE FOOD Policy since September 2019, this will be strictly enforced as we reopen. NO food from outside is allowed in the center at this time. All personal items to include "inside
shoes", additional clothing, blankets and crib sheets are to be brought upon return and LEFT at the center. We will wash and sanitize all personal items weekly. INFANTS: You still must bring pre-made bottles and baby food daily if applicable.
If my child has any of these signs of COVID-19, I will not send him/her back to school or camp until:
• My child tested negative for COVID and is otherwise well enough to go back to school or camp OR
• A healthcare provider has seen my child and documented a reason for the symptoms other than COVID
• All are true: 1) at least 10 days since the start of symptoms AND 2) fever free off anti-fever medicines for 1 day AND 3) symptoms are getting better.
If my child is diagnosed with COVID-19, I will not send him/her back to school or camp until the following:
• It has been at least 10 days since my child first had symptoms
• My child has had no fever off anti-fever medicines (ex: Tylenol, Ibuprofen) for 1 day AND
• My child’s symptoms are getting better
If someone in my household is diagnosed with COVID-19 or my child is exposed to COVID-19, I will keep him/her home for 10 days.
If someone in my household develops any symptoms from the table above, I will get them tested for COVID-19. Find your nearest testing site here: https://www.phila.gov/testing. If that person tests positive, I will keep my child home for 10 days.