EMERGENCY CONTACT PARENTAL CONSENT FORM

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

CHILD PICK-UP AUTHORIZATION

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.

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.

Agreement Form

55 PA CODE CHAPTERS 3270.123&.18l(C); 3280.123&0l81 (c); 3290.123&.18I (c)

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)

Periodic Review

ENROLLMENT AND "GETTING TO KNOW YOU" MEETING GUIDLINE

Questions that might be asked at enrollment.

"GETTING TO KNOW YOU" MEETING

Parent/Guardian

Agree to abide by the Center's Policies and Procedures

• Have read this handbook in its entirety.
• I agree to pick my child up on time.
• I understand that tuition is due every Monday or Tuesday of each week.
• I will keep my telephone and address information current at all times.
• I will keep my child's immunization record up to date at all times.
• Other  

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.

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.

We will be reopening Monday -Friday 7:30am-5:30pm. With only serving children no longer than 9 hours a day.

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.

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.

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.

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) New/Worsening Cough Shortness of Breath Sore Throat Difficulty Swallowing 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 Chills Headache 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 14 days?

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.

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.

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.

Greetings Parents,

The following program policies are designed to ensure that all enrolled children receive a quality preschool education.

Attendance Policy

Regular attendance is important for your child to maintain steady progress and to enjoy the benefits of a high-quality early childhood experience. If your child is ill or unable to attend school, please send your child's teacher a note to report the absence. Excessive absences are unacceptable and your child's enrollment in the program may be jeopardized. This policy also includes extended vacations.

• First Occurrence (3 absences): Teacher will verbally remind parents about the importance of daily attendance.
• Second Occurrence (5 absences): Teacher will meet with the parent/guardian to discuss the reason for absences and strategies to be utilized to avoid absences in the future.
• Third Occurrence (10 absences): Program director will confer with the parent regarding excessive absences and develop a plan of action to ensure daily school attendance.
• Fourth Occurrence (15 absences): Parent receives written notification that continued absences will result in child's removal from the class list.
• Fifth Occurrence (18 absences): In consultation with the program director, the child is placed back on the waiting list and the slot will be filled by the next child on the waitlist.

Thank you for adhering o the program policies. Our goal is to support children and families whenever possible and it is never our wish for a child to be dismissed from our program. We hope that these policies and procedures will provide a foundation for a strong program that will meet the needs of students, parents, and staff.

Director, Little Peoples Village

I have received and understand Little Peoples Village Attendance Policy. I agree to contact my child's teacher when my child will be absent and/or in advance if there will be any prolonged absences from school. I further understand that I will provide documentation (doctor, dentist, family notes) when my child is absent from school. I understand that excessive absences may make it impossible for my child to remain in the PKC/Head Start program.

Policy:

This policy depicts LPVs methodology of reducing and eliminating the suspension and expulsion of children

Purpose:

The purpose of this policy is to identify positive behavior support guidelines and tools to be used by teaching and non-teaching staff at LPV; to raise awareness about suspension, expulsion and excessive disciplinary practices at the early childhood level to our families; to provide support through parent partnerships to help families who are experiencing challenging behaviors in the home by providing clear, age appropriate and consistent expectations and consequences to address challenging behaviors in a fair and equitable manner.

Scope:

This procedure applies to all teaching and non-teaching staff; the guidelines are mandatory and must be practiced diligently prior to the advancement of the next tier level of addressing disciplinary action.

Authorities/Responsibilities:

It is the responsibilities of the Executive Director, Director, Assistant Director to ensure teachers are empowered to implement all positive behavior tools as outlined in this policy and to provide teachers and support staff with adequate training and resources to address challenging behaviors in the classroom. At the completion of training, all staff and support staff will be responsible to ensure are implemented.

Procedures:

Teachers will implement the following strategies on a consistent basis to reduce challenging behaviors exhibited by children. Teachers will consistently document the use of these strategies and the results, whether positive or negative, daily.

Positive Behavior Support Strategies All Teaching and Non-Teaching Staff will implement the following procedures to curtail existing challenging behaviors exhibited by children in their care

Visual Supports

• Design and post at children's eye level, a visual schedule complete with both pictures and words
• The visual schedule is utilized consistently and adapted based on student needs

Expectations

• Design with children, and post 3-5 classroom rules with pictures
• Classroom rules are positive, specific and descriptive
• Classroom procedures, responsibilities, rules are explicitly taught and reviewed frequently

Praise and Positive Reinforcement

• Behavior specific praise is used to reinforce appropriate behaviors
• Praise is used when catching students make positive choices
• Using a calm, low, neutral tone voice to provide short simple directions when redirecting inappropriate behaviors
• A ratio of 4:1 (praise to behavior correction statements) is used
• A combination of verbal and physical praise is used (e.g., thumbs up, high five, stickers, kiss your brain, tokens, etc.)

Transition Procedures

• A warning of "one more minute" or something similar is used to signal a transition
• A transition signal is used (ring bell, blow whistle, turn off lights, play a transitional song)
• Provide personal face-to-face warning to children who have difficulty with transitions
• Provide more than one reminder when possible (e.g., 5 minutes until... 2 minutes until...)
• Expected behaviors are clearly stated at transition times (e.g., hands at side, quite mouths)

Provide Alternative Choices, if possible

• Provide an alternative activity that will avoid disrupting others if child is unable or unwilling to participate in current activity
• Permit child to sit in cozy corner to read; play with a puzzle, have writing center open and stocked with crayons, markers and paper to encourage writing or drawing; permit calming music to be played and/or any other calming activity
• When child is redirected to the alternate activity, the child should be quietly praised and never punished

Allow Opportunities for helping

• Develop and implement a job chart
• Allow children to engage in jobs (e.g., wipe tables, organize toys, books, cubbies)

Introduce Scripted Stories

Implement scripted stories such as "Tucker the Turtle," and "Super Friend." Other suggested scripted stories can be located on the Center on the Social and Emotional Foundations for Early Learning (http://csefel.vanderbilt.edu/index.html)

• Teach children how to identify their feelings (e.g., use visual feeling charts, games, puppets, etc.)

Practical Teacher Engagement with an aggressive or aggravated child

Teachers can sometimes help diminish and/or eliminate student's aggressive behaviors by implementing strategies listed above; as well as practicing the following step-by-step engagement procedures:

• When a child exhibits aggressive behaviors that jeopardizes the physical safety of self, classmates and others, avoid physically handling or restraining the child. Only restrain a child if the child is a danger to himself and others
• Never grab a child by the arms; if you need to remove a child from a dangerous situation, go behind him/her, and lift the child from under the armpits
• Quickly relocate the child to a safe spot (writing center, cozy corner, etc.)
• Give the child time to calm down; do not continue talking (badgering) the child during the calm down period. Let the child process and encourage child to take deep breaths.
• During conversations with the child, keep your voice calm and in a low tone
• Ask child what else can he/she do to calm down besides deep breathing. Listen and accommodate child with responses, if possible: count fingers, draw, exercise, etc.
• Eliminate calling out a child's name repeatedly- It is bad press! It causes the child to be put on the spot; it encourages bad behavior and it gives other children a name to blame.
• Once child has calmed down, revisit the discussion about what made the child upset and revisit alternative behaviors

If the above strategies fail to change inappropriate behaviors, advancement to the next level on the progressive disciplinary procedure will be implemented for the individual child.

• Design specific strategies for individual children
• Revisit the Tucker the Turtle Story daily and continue to have children practice the steps
• Tailor the Tucker story to fit individual students (e.g., include child's name, specific behaviors exhibited by child, add child's picture, etc.)
• Encourage and praise child for expressing his/her feelings
• Remind him/her of strategies to regulate him/herself (e.g., counting down from 10, taking a walk, deep breathing, etc.)

If the use of these additional intervention strategies fails to improve challenging behaviors exhibited by children, advancement to the next level on the progressive disciplinary procedure will incur.

If the use of these additional intervention strategies fails to improve challenging behaviors exhibited by children, advancement to the next level on the progressive disciplinary procedure will incur.

Required Parent Conferences

• Center director initiates a parent conference to discuss individual children's challenging behaviors
• Director and parent collaborate to develop and implement an individualized plan to address learning goals and behaviors. Discussion will be held with child to demonstrate the partnership between the school and home. Director and parent will set a time-line and meet again to discuss child's progress
• If behaviors continue, director will initiate another parent conference to revisit strategies implemented both at home and at school
• If behaviors continue to persist, director initiates another parent conference to discuss agency intervention

Implement Agency Intervention

• Director discusses with parents about agency intervention, if needed. Parents are provided contact information on our Mental Health Consultant and an appointment will be arranged.
• Parent meets with the Mental Health Consultant and if agency intervention is required, parent provides permission for child to be screened
• Director suggests parents take a dual-action approach in obtaining services; parent must contact outside services recommended by center as well as contact their individual insurance companies to get recommendations of other agencies to contact. Director provides recommended locations including:

Birth to 3 years of age:

• Community Behavioral Health (http://dbhids.org/) - 215-413-3100
• City of Philadelphia Early Intervention Intake (Childlink) - 215-685-4646

3 to 5 years of age:

• Child Crisis Treatment Center - 215-496-0707
• Etwyn - 215-895-5500
• Child Guidance Center- 267-713-4100
• Community Council - 215-473-7033
• Philadelphia Mental Health Clinic- 215-735-9379
• NorthEast Treatment Center - 215-451-7000
• Preschool Family Intervention Center through the Community Council - 215-473-7033

• Director provides 15 days for parent to contact suggested providers and insurance company to schedule an appointment for child evaluation.
• Call and Retrieve Procedure: During the 15-day period, the parent will be called if the child continues to injure him or herself; another child, a teacher or a staff person, and the student must be picked up within one hour. If the parent does not pick up the child within one hour, the child will not be able to return the next day.
• If the parent refuses to seek additional help within the required timeline of 15 days, and if the child continues to injure him or herself; another child, a teacher or a staff person, the parent will be called to retrieve the child for the day. The parent will be given one hour to pick up the child. If the parent fails to pick up the child within one hour, the parent will have to keep the child home the following day.
• If parent fails to pick up their child within one hour after two consecutive occasions, the parent will incur a late fee of $25.00 per hour until the child is picked up.
• If the child continues to be incontrollable, and causes injury to him or herself, peers, teachers or staff persons; and/or child attempts to destroy center property, the parent will be called to retrieve the child, within one hour; and if behaviors persist for several days in a row, the parent will be required to keep the child home for a cool-down period of 1-3 days.
• Parents must provide an appointment card to demonstrate good faith in scheduling the appointment.
• The call and pick up procedure as described above will continue during scheduling of appointment and evaluation.
• If parents fail to complete an evaluation within the second 15-day extension, the parent will be informed their child will be placed back on the waiting list for 30 days until an evaluation has been completed. As an alternative, the parent can provide their own wrap-around service for their child.
• This extension will be the final opportunity for the parent to get child evaluated. During this holding period, parent is not responsible to make their copayments
• Failure of the parent to complete an evaluation within the timeframe will result in the child being placed back on the waiting list until such services have been provided, and the childcare slot will be opened to other parents seeking childcare.
• During the holding period, the call and retrieval of child for incidences of aggression that hurts child, teacher, peers or staff will continue until evaluation.
• This extension will be the final opportunity for the parent to get child evaluated. During this holding period, parent is not responsible to make their copayments. Failure of the parent to complete an evaluation within the timeframe will result in the child being placed back on the waiting list until child have been evaluated and/or center support has been provided by the parent.

Extreme Circumstances:

• If a child has demonstrated extreme aggression towards him or herself; teachers, staff and/or other children on a consistent basis, the above process will be eliminated, and the parent will be required to seek intervention on their own (resources provided in this policy) immediately prior to the child being able to return to the center. The parent must demonstrate good faith by submitting an intake appointment card with an upcoming date for the child to return and provide follow-up documentation indicating that the parent and child completed their intake services will be rendered to help support the child's aggressive behavior at the center and towards others. If the parent fails to keep the appointment, the child will be placed back on the waiting list until the services has been provided.
• Any child that has been extremely aggressive and has broken any of the classrooms items, the parent will be responsible for replacement and/or purchase of the broken item.

Director's Name and Title

Director, Little Peoples Village II

I have received and understand Little Peoples Village Suspension and Expulsion Policy. I agree to adhere to the contents within.

Little People’s Village

CHILD and FAMILY INFORMATION FORM

The information and documentation you provide will assist the Office of Early Childhood Education in determining your eligibility for The School District of Philadelphia's preschool program, You are obligated to provide accurate and complete information. Deliberate misrepresentation of your information may subject you to prosecution under applicable Federal and/or State laws. PLEASE PRINT CLEARLY and use BLUE or BLACK INK.

Section 1: LOCATIONS

CHOOSE THE LOCATION(S) WHERE YOU WOULD LIKE YOUR CHILD TO ATTEND: Review the 2017-2018 School-Based Preschool Locations on pages 5-6. Select 1, 2 or 3 locations in preference order. If your child is accepted to preschool, the locations you select and the availability of funding in those locations will determine which location is chosen for your child, BEFORE-SCHOOL, AFTER-SCHOOL and TRANSPORTATION ARE NOT PROVIDED. You must be able to bring your child to school and pick up your child from school on time.

Section 2: CHILD

Race/Ethnicity Select all that applies

Mother Complete if child does not live with his/her mother

Father Complete if child does not live with his/her father

Little People’s Village

#1 CHILD and FAMILY INFORMATION FORM

Section 2: CHILD. continued

Child's Doctor

Child's Dentist

#1 CHILD and FAMILY INFORMATION FORM

Section 3: PRIMARY PARENT

The adult who is primarily responsible for the care and well-being of the child.

Employer Information Complete if you are Employed/Self-Employed

School/Job Training information Complete if you attend High School, College or a Job Training program

Section 4: SECONDARY PARENT

An adult who shares in the care of the child.

Employer Information Complete if you are Employed/Self-Employed

School/Job Training information Complete if you attend High School, College or a Job Training program

Section 5: FAMILY MEMBERS

List your name, the name(s) of your child(ren) and the names of all other adults and children who live with you in your home. Use additional paper if needed

Section 6: FAMILY INCOME

Indicate how you financially provide for your family. Select each source of income that the Primary Parent, Secondary Parent and all children receive.

Section 7: SIGNATURES

Read the following and sign where indicated.

l/We have completed all sections on my/our Child and Family Information Form and certify the information is correct. I/We understand that if any of my/our information is false, my/our participation in the preschool program may be terminated and l/we may be subject to legal action. l/We have attached a copy of my/our child's proof of date of birth, verification of my/our Philadelphia, PA address and copies of all income and monthly benefits that I/we and my/our children receive. l/We understand that this information is being given so that my/our eligibility can be determined for The School District of Philadelphia's preschool program. I/We understand that officials from The School District of Philadelphia, the Department of Health and Human Services and the Commonwealth of Pennsylvania will have access to and may verify the information and supporting documentation submitted with my/our Child and Family Information Form. l/We further understand that, if necessary, additional documents may be requested and I/we will comply with this request. l/We understand that my/our child's complete Preschool Application is confidential and will be held in strict confidence within The School District of Philadelphia and affiliated Community Nonprofit Partner Agencies that have been determined to be school officials under the Family Educational Rights and Privacy Act with legitimate educational interests as part of The School District of Philadelphia's preschool program.

#5: CHILD'S DIETARY or FOOD RESTRICTIONS FORM

Dear Parent/Guardian, The Child and Adult Care Food Program (CACFP) provides a daily nutritional breakfast, lunch and snack for your child at no cost to families. A monthly menu, posted in each location, lists the foods and beverages that your child is offered at each meal. The Office of Early Childhood Education recognizes the fact that certain foods, due to medical, religious or other reasons, are restricted from some children's diets. Please tell us about your child. This information will be shared with your child's nutritional, health and instructional staff. If your child has a non-disabling dietary restriction, efforts will be made to provide your child with an allowable substitution,

If your child has a food allergy or medical dietary concern that restricts his/her diet, the enclosed Medical Plan of Care Form for the Child ond Adult Care Food Program (Pages 33-34) must be completed by an appropriate health care professional and submitted with your child's Preschool Application. If your child has a food allergy which requires the administration of an EPI-PEN, Benadryl or other medication, please let us know immediately so that we can begin the process required to train the preschool staff.

Please check one box and complete as necessary — use additional paper if needed:

#2: CHILD’S MEDICAL CONCERNS FORM

Dear Parent/Guardian, The Office of Early Childhood Education recognizes the fact that some children have a medical condition that requires prescribed medication. When the prescribed medication is to be administered during preschool hours, a representative from Early Childhood Health Services, with written permission, will train the staff at your child's preschool to administer the medication to your child. Written permission is given by submitting form MED-1: Request for Administration of Medication, completed by you and your child's health care provider for each medication. At no time will medication be given to your child without a completed MED-1.

Please check one box and complete as necessary - use additional paper if needed:

THE SCHOOL DISTRICT OF PHILADELPHIA OFFICE OF EARLY CHILDHOOD EDUCATION 110 N BROAD STREET SUTIT 170 PHILADELPHIA PENNSYLVANIA 19130

Part I: Place a check mark in the No or Yes Column next to each item. For all Yes responses, please explain in the Comments column

Little People’s Village

This form will be taken with your child when emergency medical care is needed.