Pre-K Counts/Headstart Program Enrollment Part 2

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PLEASE PUT YOUR INITIALS NEXT TO WHAT IS APPLICABLE FOR YOUR CHILD:

MM slash DD slash YYYY
Orientation - I understand that I MUST attend a mandatory orientation before my child can start. The date and time will be scheduled by LPV.
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IEP/IFSP

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.

I am providing a copy of my child's lEP or IFSP.
I am not providing a copy of my child's IEP or IFSP and/or this is not applicable to my child.
PICTURE

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.

TRANSFERRING RECORDS

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.

My Child Wears Diapers or Pull-ups
My Child Wears Glasses or has a lazy eye, crossed eye, wandering eye or other eye condition
My Child Has ear tubes, hearing loss, wears a hearing aid, has a history of ear infections or other ear conditions
My Child Has excessive colds, sore throats, coughing episodes, snores loudly
My Child Has a history of asthma or bronchitis
My Child Has a heart murmur, a resolved heart murmur, rheumatic fever or other heart conditions
My Child Has a history of anemia, sickle cell disease, elevated lead level
My Child Has G6PD, hemophilia, or other blood conditions
My Child Has an umbilical or inguinal hernia
My Child Has reflux, stomach pain, diarrhea, constipation, trouble urinating, urinary tract infection or kidney disease
My Child Has a feeding tube
My Child Has diabetes (If yes, please indicate Type I or Type Il)
My Child Has rashes, eczema, hives, boils
My Child Has neuropathy, muscle tics, spina bifida, muscular dystrophy, cerebral palsy
My Child Wears leg braces, uses a cane, walker, or wheelchair
My Child Has/had polio, chicken pox, measles, mumps, scarlet fever, whooping cough
My Child Experiences car sickness