Wee Tots

CURRENTLY UNDER CONSTRUCTION PLEASE DO NOT REGISTER FOR NOW!!!!!

Registration Packet - 2020/2021 - Wee Tots

Step 1 of 5 - Family Info

Wee Disciples Christian Academy - Wee Tots Registration
WEE DISCIPLES WEE TOTS CLASS
*
My child will be two as of 6/30/2020 and is planning to enroll in the Wee Tots T/TH Class at $1,170.00 per year ($130.00 per month). Time: 9:15 – 11:30.*
A non-refundable, one-time registration fee of $70.00 will be billed and paid to FACTS, our tuition management company. Your registration will be complete once this fee is paid.

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Wee Disciples Christian Academy - Wee Tots Registration
Wee Disciples Christian Academy Emergency Form
EMERGENCY TREATMENT
A. Family Information
1. Child’s Full Name:*
Birth Date:*
Sex:*
- Male
- Female
Home Address:*
Street Address Address Line 2 City State ZIP Code
Child’s Doctor:*
Doctor’s Phone:*
Doctor’s Address:*
Street Address Address Line 2 City State ZIP Code
Insurance Company:*
Policy Number:*
Preferred Hospital/Clinic for Emergency Care:*
2. Mother/Guardian Name:*
Phone:*
Mother/Guardian Address:*
Street Address Address Line 2 City State ZIP Code
Mother/Guardian Employer Name:*
Work Phone:*
Mother/Guardian Employer Address:*
Street Address Address Line 2 City State ZIP Code
3. Father/Guardian Name:*
Phone:*
Father/Guardian Address:*
Street Address Address Line 2 City State ZIP Code
Father/Guardian Employer Name:*
Work Phone*
Father/Guardian Employer Address:*
Street Address Address Line 2 City State ZIP Code
B. Emergency Contacts:
Names, complete address, and telephone numbers of individuals to contact in case parents cannot be reached in an emergency:
Emergency Contact 1. Full Name:
Emergency Contact 1. Phone:
Emergency Contact 1. Address:
Street Address Address Line 2 City State ZIP Code
Emergency Contact 2. Full Name:
Emergency Contact 2. Phone:
Emergency Contact 2. Address:
Street Address Address Line 2 City State ZIP Code
Emergency Contact 3. Full Name:
Emergency Contact 3. Phone:
Emergency Contact 3. Address:
Street Address Address Line 2 City State ZIP Code
C. Pick Up:
List of people with permission to pick child up from care (anyone not listed cannot pick up child without written permission from parents):
Pick Up 1. Full Name:
Pick Up 1. Phone:
Pick Up 1. Address:
Street Address Address Line 2 City State ZIP Code
Pick Up 2. Full Name:
Pick Up 2. Phone:
Pick Up 2. Address:
Street Address Address Line 2 City State ZIP Code
Pick Up 3. Full Name:
Pick Up 3. Phone:
Pick Up 3. Address:
Street Address Address Line 2 City State ZIP Code
Special Instructions (if applicable):
Biological/Custodial parents must be given access to their children unless there is a court order preventing contact. Individuals with court orders against them preventing child pick up:
Name*
Relationship to Child*
Name*
Relationship to Child*
Other restrictions on child pick up*
D. Allergies/Medications
List any allergies, illnesses, regular medications, special needs including dietary needs and concerns*
E. Permission to Receive Medical Care
I,*
give my permission for Wee Disciples Christian Academy to provide consent for*
to receive emergency medical, dental or surgical treatment if I cannot be reached. I place the following restrictions on medical treatment :*
F. Permission to Transport
Permission to Transport*
- I do not give the childcare provider permission to transport my child for non-emergency reasons.
- I give the childcare provider permission to transport my child for non-emergency reasons, such as to and from school or school activities, shopping, field trips. etc.
- In the event of an emergency, I prefer that the childcare provider call an ambulance to transport my child.
- In the event of an emergency, I give permission for the childcare provider to transport my child.
I place the following restrictions on transportation*
Date*
Parent/Guardian Signature*
(The completed form will be signed and dated at parent orientation.)
Wee Disciples Christian Academy

114 Poor Farm Road, Suite 101
Kearneysville, WV 25430

(304) 707-6812

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Wee Disciples Christian Academy - Wee Tots Registration
MEDIA/PHOTOGRAPHY
CONSENT AND RELEASE FORM
As the parent/guardian of*
I agree to the following:
- I understand that my child may be videoed/photographed at Wee Disciples Christian Academy during normal school hours, activities, or events.
- I understand that these photographs may be used throughout the school, on Wee Disciples Christian Academy’s Facebook page, in local newspapers, and/or on the school’s website or other
  public relations materials produced by Wee Disciples.
- I understand Wee Disciples Christian Academy will protect my child’s identity and will not publish my child’s name if a video/photograph of my child is used as described above.
- I understand that such photographs shall become the property of Wee Disciples Christian Academy, which has the right to duplicate, reproduce, and/or make other uses as Wee Disciples Christian Academy deems necessary.
Please check the appropriate statement:*
- Yes, I confirm that I have read and understand the above and thereby give consent for use of my child’s photograph/video as described above.
- No, I do not wish to have my child videoed/photographed.
Your Name*
Date*
Signature*
Wee Disciples Christian Academy

114 Poor Farm Road, Suite 101
Kearneysville, WV 25430

(304) 707-6812

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Wee Disciples Christian Academy - Wee Tots Registration
Notification Request Form
Pesticide Levels 3 and 4

Level 3 EPA Caution (crack & crevice treatments)
Level 4 EPA Warning or Danger (broadcast spraying and fogging)
Do you as a parent or legal guardian wish to be informed at least 24 hours in advance if an application of Level 3 or 4 pesticides will be used at Wee Disciples?*
A notice will be available 24 hours in advance of pesticide application. The notice will be placed at the sign in/out book.
- Yes
- No
Child’s Name*
Parent or Guardian’s Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email

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To complete the registration process you MUST set up a tuition management plan through FACTS.

Please return completed Health Assessment and immunization records, by mail or email, within 30 days of completing registration packet.

Health Assessment

Wee Tots

CURRENTLY UNDER CONSTRUCTION PLEASE DO NOT REGISTER FOR NOW!!!!!

Registration Packet - 2020/2021 - Wee Tots

Registration Packet - 2020/2021 - Wee Tots

Step 1 of 5 - Family Info

Wee Disciples Christian Academy - Wee Tots Registration

Wee Disciples Christian Academy ®

REGISTRATION FORM – 2020/2021

DIAPER CHANGING AUTHORIZATION FORM

ADDITIONAL INFORMATION

Wee Disciples Christian Academy - Wee Tots Registration

WEE DISCIPLES WEE TOTS CLASS

Wee Disciples Christian Academy - Wee Tots Registration

Wee Disciples Christian Academy Emergency Form

A. Family Information

B. Emergency Contacts:

C. Pick Up:

Special Instructions (if applicable):

D. Allergies/Medications

E. Permission to Receive Medical Care

F. Permission to Transport

Wee Disciples Christian Academy

Wee Disciples Christian Academy - Wee Tots Registration

MEDIA/PHOTOGRAPHY

Wee Disciples Christian Academy

Wee Disciples Christian Academy - Wee Tots Registration

Notification Request Form

Pesticide Levels 3 and 4

Level 3 EPA Caution (crack & crevice treatments)
Level 4 EPA Warning or Danger (broadcast spraying and fogging)

Site Links

Get In Touch!

REGISTER NOW!

Wee Tots

CURRENTLY UNDER CONSTRUCTION PLEASE DO NOT REGISTER FOR NOW!!!!!

Registration Packet - 2020/2021 - Wee Tots

Registration Packet - 2020/2021 - Wee Tots

Step 1 of 5 - Family Info

Wee Disciples Christian Academy - Wee Tots Registration

Wee Disciples Christian Academy ®

REGISTRATION FORM – 2020/2021

DIAPER CHANGING AUTHORIZATION FORM

ADDITIONAL INFORMATION

Wee Disciples Christian Academy - Wee Tots Registration

WEE DISCIPLES WEE TOTS CLASS

Wee Disciples Christian Academy - Wee Tots Registration

Wee Disciples Christian Academy Emergency Form

A. Family Information

B. Emergency Contacts:

C. Pick Up:

Special Instructions (if applicable):

D. Allergies/Medications

E. Permission to Receive Medical Care

F. Permission to Transport

Wee Disciples Christian Academy

Wee Disciples Christian Academy - Wee Tots Registration

MEDIA/PHOTOGRAPHY

Wee Disciples Christian Academy

Wee Disciples Christian Academy - Wee Tots Registration

Notification Request Form

Pesticide Levels 3 and 4

Level 3 EPA Caution (crack & crevice treatments) Level 4 EPA Warning or Danger (broadcast spraying and fogging)

Site Links

Get In Touch!

REGISTER NOW!

Level 3 EPA Caution (crack & crevice treatments)
Level 4 EPA Warning or Danger (broadcast spraying and fogging)