Highlands Baptist Learning Center

Child__________________________________________ Todays Date _________________

Birthdate______________Sex____Home Phone___________Child Lives with Mother___Father___Other_
Home Address_________________________________________City__________________Zip_________
Mailing Address________________________________________City__________________Zip_________
Mothers name_____________________________________Occupation______________SS#__________
Employer________________________________Work Phone_______________Cell/Pager#___________
Church Preference/Membership____________________________________________________________
Fathers name______________________________________Occupation_____________SS#__________
Employer________________________________Work Phone______________Cell/Pager#____________
Church Preference/Membership____________________________________________________________
Highlands Baptist Learning Center is a ministry and governed by Highlands Baptist Church. I understand I may be contacted by a
staff or member of this church to welcome us to the family of Highlands Baptist Learning Center.

Other children/ages_____________________________________________________________________
Persons permitted to remove the child: Mother - Yes_____No_____Father - Yes______No________
(If a parent is not permitted to remove the child, the center must have court documents.)
Others:
Name_______________________________________________Phone_____________________________
Address________________________________________________Relationship to child_______________
Name________________________________________________Phone____________________________
Address________________________________________________Relationship to child_______________
In this school, we will love and affirm your child by respecting his unique personality. Discipline means guidance or teaching, and
we will strive to guide your child to become self-controlled and self-directed through methods of positive reinforcement. We expect
parent cooperation in this effort.
Child Care fees for children enrolled in the full day program of the center include preschool fees. Your account will be billed each
Monday, even if your child is absent from the center. Fees for the child enrolled in the preschool program only will be billed on the
1st of each month. Tuition is due on the first of the month for ten months - August 1st through May 1st. Full day enrollees should
pay each Monday. Registration fees are not refundable.

3530 SE Fort King Street * Ocala, Florida 34470 * 352-694-2194

Association of Christian Schools, International

Childs Personal Information

Childs Name________________________________________________________________________
Has child had a previous group/preschool experience? If so, where and when?
___________________________________________________________________________________
____________________________________________________________________________________
Mark conditions that apply to the child:
_____asthma _____diabetes ______eczema ______allergies
_________bladder/bowel problems
_________special diet (parent will need to supply center with listed allergies and/or special diet foods)
Explain any medical problem and care needed:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Any additional helpful information such as childs communication, comforting, discipline, etc.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Childs Physician
_____________________________________________Phone______________________

I understand that all medication brought to the center must be in the original container. The medication
must
also be checked in with staff on duty and our special permission form filled out in order to administer the
medication. I also hereby grant permission for my child to be photographed while attending Highlands
Baptist Learning Center.

____________________________________________________________________________________
Parent Signature
Date

Highlands Baptist Learning Center

Emergency Consent Form
____________________________________________________________________________________
Childs Name
Birth Date
____________________________________________________________________________________
Address
City
Zip
In the event of an emergency, please contact:
____________________________________________________________________________________
Mother
Daytime Phone Number
____________________________________________________________________________________
Father
Daytime Phone Number
____________________________________________________________________________________
Relative/Friend
Daytime Phone Number
If contact unsuccessful, I hereby give my consent for the administering of treatment deemed necessary
by a licensed physician/dentist or emergency room facility.
____________________________________________________________________________________
Childs Doctor
Phone
____________________________________________________________________________________
Childs Dentist
Phone
____________________________________________________________________________________
Insurance Carrier
Policy Number
____________________________________________________________________________________
Signature Parent/Guardian
Date

Highlands Baptist Learning Center admits students of any race, color, national or ethnic
origin to all rights, privileges, programs, and activities generally accorded or made
available to children enrolled in the center. It does not discriminate on the basis of race,
color, national and ethic origin in administration of its policies and administered
programs. The IRS Revenue Procedure 75-50 requires schools to keep records on the
racial composition of its student body, faculty, and administrative staff for each
academic year. Please provide the school with your social designation:
______________________

Discipline Policy
Highlands Baptist staff will love and affirm your child by respecting his/her unique
personality. Discipline means guidance or teaching, and we will strive to guide your
child to become self-controlled and self-directed.
We do not view discipline as punishment but, rather as correction. Children may
be corrected for displaying behavior such as:
1. Actions that disrupt the group or interfere with a learning activity.
2. Actions that could possibly cause physical/emotional harm to the child or
classmates.
3. Actions in direct violation of a well-explained center/classroom rule.
4. Willful disrespect toward the teacher or another classmate.
5. Use of profane/unwholesome language.
Most correction will be handled by the teacher through a reminder or by
restricting the childs freedom or privileges (Time Out). Parents will be notified if
continued problems exist. In cases where a problem persists and there is no behavior
change, a child will be sent to see the Director. Parents will be notified if the child is
sent to the office. Children who consistently fail to respond to efforts of correction may
be dismissed. Much care is taken to insure that correction is handled properly and
without anger. Perfection in behavior is not expected, but reasonable cooperation by
the child is expected.
Parents are expected to support and uphold the centers policies. Without this
cooperation and confirmation from the parents, a double standard exists between the
home and center. This is counterproductive to the childs development and the centers
effectiveness.
If at any time misunderstandings develop between the center and the home, it
becomes the obligation of both to resolve these in a Biblical fashion; that of going
directly to the parties involved for clarification and explanation.
The center confesses that although all teachers are chosen for their Christian
commitment and high ideals, this, however, does not make them immune from error. All
suggestions and comments from parents will be examined fully, and are welcomes and
encourages for the overall strengthening of the center.

______________________________________________________________________
Parent Signature
Date

Weekly Fee Contract

This is a contract between _____________________________________ and Highlands Baptist

(name of parent)
Learning Center for the care and education of _____________________________________ for five days
(name of child)
per week, Monday through Friday. _______________________________ will not be brought to the
(name of child)
center before 7:00 a.m. and will not be picked up later than 5:30 p.m.
The fee will be $_____________ per week, payable on Monday of each week.
A registration fee of $_______________ has been paid and is non-refundable.
I have read and understand the policies in the parent handbook. I understand that if my balance reaches
the amount of $300.00. I will be asked to remove my child until the balance is settled. I understand in
this process my child may loose his/her place in Highlands Baptist Learning Center. I understand that if
payment is in default for any reason and the account is turned over to a collection agency I will be held
responsible for any charges incurred.

Signature of Parent_______________________________________ Date_________________________

Driver's License # of Parent______________________________________________________________
Signature of Director _____________________________________ Date ________________________