Enrollment Form

Completing this form as accurately as possible will ensure we have adequate staff scheduled to care for your child.

I hereby authorize Paducah Day Nursery to obtain any emergency medical care deemed necessary. In the event of an emergency or illness, Paducah Day Nursery, Inc. will transport my child to Western Baptist Hospital or the nearest medical facility to the child’s location. I understand that any medical expenses that may be incurred are the responsibility of the parent/guardian.

I hereby release to and hold harmless the Paducah Day Nursery, its officers, agents, funding sources and/or representatives the right of my and/or my child/ward’s photograph, image, likeness, voice as recorded on videotape or film and any oral or written statement(s) regardless of format (whether they are direct quotes or paraphrased by Paducah Day Nursery) for the purpose of promotional activities, publications and marketing material including internet publications related to participation in any/all Paducah Day Nursery programs. I acknowledge that this release is legally binding and understand that this is my final notice regarding this matter and that Paducah Day Nursery, its officers, agents, funding sources and/or representatives may proceed in reliance thereon. The undersigned agrees to making their and/or their minor child/ward’s image, likeness or voice and/or oral or written statement(s) available for program marketing of Paducah Day Nursery. I, on behalf of myself and /or my minor child/ward hereby release, indemnify and hold harmless Paducah Day Nursery, its officers, agents, funding sources and/or representatives from and against any and all claims, losses, suits, damages, or costs (including reasonable attorney’s fees) arising out of, resulting from or relating to my and/or my minor child/ward’s participation in Paducah Day Nursery marketing publication(s).

I further acknowledge that I am a person of legal age and the custodial parent/guardian of the minor child/ward identified in this enrollment form and I am authorized to execute this release. I have read this release in its entirety; I fully understand and accept its terms; and, I have executed by affixing my signature to this release voluntarily.

I give permission for Paducah Day Nursery staff to take my child on the community playground here at Elmwood court, and for them to walk, or ride in bye bye buggy around the area surrounding Elmwood Court. This will be a daily activity that Paducah Day Nursery will be doing as the weather permits. I have read this release in its entirety; I fully understand and accept its terms; and, I have executed by affixing my signature to this release voluntarily.

I give permission for my child to feed and observe the fish in our aquarium at Paducah Day Nursery.

I give permission for my child to be transported to and from their school by Paducah Day Nursery.

I/We understand that I/We am/are responsible for meeting all of the requirements for enrolling my/our minor child in services provided by Paducah Day Nursery. I/We also understand that withholding information on this enrollment form or giving false information can result in a determination of ineligibility and thus, subject to expulsion. Therefore, I/We certify that all statements on this form are correct and complete.

Payment for all childcare services is due and payable weekly, unless an alternate payment plan is agreed upon and approved by the Executive Director. The due date should usually fall on the Friday of each week. Payment for hours in excess of the contracted hours are due and payable in full on my child’s next regularly scheduled visit to Paducah Day Nursery. A $25 charge will be assessed for all returned checks. Checks returned NSF must be redeemed with cash or certified funds. A $5.00 per day late fee will be charged when payment of childcare fees are not made on the designated payment date.

Payment for hours, in excess of contracted hours (overtime), are due immediately.

Please note that families with Audubon Childcare Subsidies are responsible for insuring contracts are current. In the event that a childcare subsidy is terminated and/or discontinued, payment for daily childcare services must be made by the parent at the Audubon rate until a revised enrollment form is completed and negotiated.

Should Paducah Day Nursery management determine that a child cannot adjust to the programs and philosophy of Paducah Day Nursery, I/We understand that a two (2) week notice will be given that services to me/my child and the agreement outlined herein will be terminated.

The following are considered grounds for immediate termination of services from Paducah Day Nursery: 1. Repeated late payment of childcare fees. 2. Repeated disregard for Paducah Day Nursery’s written rules and regulations. See “Parent Handbook”. 3. Failure to provide/regularly updated contact information 4. Failure to provide basic supplies such as diapers or baby wipes.

This service agreement and/or rates for childcare are subject to change with a thirty (30) day written notice delivered in writing to either party.

I have read and fully understand the conditions for enrollment at Paducah Day Nursery and, by affixing my signature, agree to comply with the terms and conditions outlined herein.