Please print the application below, fill it out and bring it with you when you come in.

9318 Pensacola Blvd.
Pensacola, FL.
Phone: 478-5733
License # DC-1041-E		 7181 Pine Forest Road
Pensacola, FL.
Phone: 944-5140
License # DC-1132-E

Child Information

Last ________________________ First ______________________ Middle _________________

Nickname __________________________ Date of Birth _____________________

Address _________________________ City _____________________ State _______ Zip _______

 

Home Phone ___________________

Parent’s Information

Mother’s Name ________________________

Home Address ________________________________________________

Employer ________________________

Work #________________________ Cell # ________________________

Father’s Name ________________________

Home Address ________________________________________________

Employer ________________________

Work #________________________ Cell # ________________________

Medical Information

Child’s Physician ________________________

Address ________________________________________________

Phone # ________________________

May another physician be contacted if main physician is unavailable? Yes ____ No ____

List any current or previous medical conditions, allergies, and medication:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Other Persons to be notified in case of illness or accident:

Name, address, phone #: ________________________________________________________________________

Name, address, phone #: ________________________________________________________________________

Additional Contacts

Persons permitted to remove child:

Mother Yes _____ No ____

Father Yes ____ No ____

Name, address, relationship ________________________________________________________________________

Program

List type of program interested in: Full Day ____ Half Day ____

Which Days?

All ____ Mon ____ Tue ____ Wed ____ Thu ____ Fri ____

Agreement of fees ____ Date enrolled ________

How did you find out about Malena’s Mini School?

________________________________________________________________________________________________

Our goal is a positive and total care program designed for your child’s needs. Emotional and intellectual growth is stimulated where children learn as they play. The joy of discovery is leanred in our year round program including field trips, academics, and guidance. Gymnastics is offered at an additional cost. Nutritionally sound meals are provided. Our staff includes degreed teachers. Enrollment with us is a quality investment in your child’s future.

Malena’s Mini School Policies & Procedures

Enrollment and Payments:

  1. Our center opens at 6:30 A.M. and closes promptly at 6:00 P.M. If you do not pick up your child by closing time, a late fee of $15 per 15 minutes will be charged.
  2. A calendar will be provided with dates the center will be closed.
  3. An annual registration fee of $50 covering administrative costs and supplies is payable when your child enrolls or re-enrolls, once each year. This registration fee is non-refundable.
  4. All tuition fees are due on Monday for the current week. A late charge will be added for tuition, if received after Monday.
  5. All returned checks will be charged a fee.
  6. If your child is present one or more days a week, there will be a charge of full tuition.
  7. After your child has been enrolled, and with prior notification to your director, your child may be absent from the center only two weeks per year without charge. After the one week, half of the regular tuition will be charged to reserve your child’s enrollment.
  8. To comply with state standards, all registration forms, including child’s health records, must be completed before attendance begins. These records will need to be updated yearly.

General Information

  1. Please bring of change of clothing clearly labeled with the child’s name. These should be left at the center in case of an accident.
  2. Parents, please do not allow your child to bring toys to school.
  3. Nutritious breakfast, lunch and snack are served daily. These menus will be posted weekly for your reference.
  4. A naptime is provided for the children.
  5. If your child needs to take medicine while at school, a sign in sheet is provided for the list of medication, dosage, time given, and your authorizing signature. All medicines must be clearly labeled with the child’s first and last name. These medicines must be signed daily.
  6. For your child’s safety, please see that your child is left with a staff member before you depart. The teacher is to be notified when your child is ready to leave the building.
  7. We cannot care for sick children at school, as we do not have the special staff, or the facilities to do so safely.
  8. Parents will provide us with a list of all persons authorized to pick up your children. Please notify us if there is to be a change in normal pick up.
  9. If your child is scheduled to be picked up by our school bus from a public school, but will not need our services, please notify us at least one hour before our scheduled pick up time.
  10. At Malena’s Mini School, every effort is made to provide a happy learning experience. Positive reinforcement encourages appropriate behavior in children. When necessary, supervised isolation from the group may be used as a form of discipline.

I have read and agree to the policies and procedures of Malena’s Mini School.

Parent _______________________________________________

Date __________

Director _______________________________________________

Child Care Facility Brochure Statement

(Chapter 402.3125, F.S.)

On, ________________, 20____, I __________________________________________________ (name of parent or legal guardian) received a copy of the Child Care Facility Brochure.

__________________________________________________ (Signature of Parent or Legal Guardian)

__________________________________________________ (Name of Child)

Permission Forms

Water Activities

My child, ________________________________________, has my permission to participate in water activities planned by Malena’s Mini School. I understand that my child will be continously supervised by at least two adults, and safety rules will be enforced. This is not intended as a waiver, or a release of any legal responsibility.

Signature of Parent or Legal Gaurdian __________________________________________________

Date __________

Field Trips

I give my permission for my child, ______________________________________________, to be transported by Malena’s Mini School on field trips.

Signature of Parent or Legal Gaurdian __________________________________________________

Date __________

School Bus

My child, ________________________________________________, has my permission to be transported by Malena’s Mini School  to and/or from __________________________________________________ Elementary School.

Signature of Parent or Legal Gaurdian __________________________________________________

Date __________