The Virginia State Law requires an annual update in information. Please complete this form to its entirety!
If a currently enrolled family referred you to our center, please share the parents full name so they may receive a $25 in-house credit. Type “n/a” if not applicable
CHILD INFORMATION:
UPLOAD:
1. Proof of birth (BIRTH CERTIFICATE), recent immunizations, and last physical/well visit. Your child CANNOT START UNTIL RECEIVED!
2. Parents are required to obtain these documents. Graceachild Academy USA DOES NOT REQUEST DOCUMENTS FROM THE SCHOOLS! Click this link to complete needed forms if you have not done so already for the school:
School Entrance Health Form (PDF)
— THESE MUST BE COMPLETED BY YOUR CHILD’S PHYSICIAN.
4. YOU MAY UPLOAD THEM BELOW OR SCAN & EMAIL to: [email protected]
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Date of Birth:
Payment for the camp weeks you reserve will be processed each Thursday prior to the week of attendance. If you need to change weeks, you
MUST NOTIFY our Account Manager, Casey Gutierrez via email at:
[email protected] before payment is processed. If email notification is received to change weeks
AFTER payment was processed, you may transfer payment to a different week, however there will be
NO REFUNDS if your child is a “NO SHOW” for the reserved week.We will let you know ahead of time when your child will need to wear their swimsuit. On swim days, you will need to supply them with a change of clothes & a towel inside of a plastic grocery bag so that wet clothes can go back in it to return home in.
Date of Birth:
Payment for the camp weeks you reserve will be processed each Thursday prior to the week of attendance. If you need to change weeks, you
MUST NOTIFY our Account Manager, Casey Gutierrez via email at:
[email protected] before payment is processed. If email notification is received to change weeks
AFTER payment was processed, you may transfer payment to a different week, however there will be
NO REFUNDS if your child is a “NO SHOW” for the reserved week.We will let you know ahead of time when your child will need to wear their swimsuit. On swim days, you will need to supply them with a change of clothes & a towel inside of a plastic grocery bag so that wet clothes can go back in it to return home in.
Payment for the camp weeks you reserve will be processed each Thursday prior to the week of attendance. If you need to change weeks, you
MUST NOTIFY our Account Manager, Casey Gutierrez via email at:
[email protected] before payment is processed. If email notification is received to change weeks
AFTER payment was processed, you may transfer payment to a different week, however there will be
NO REFUNDS if your child is a “NO SHOW” for the reserved week.We will let you know ahead of time when your child will need to wear their swimsuit. On swim days, you will need to supply them with a change of clothes & a towel inside of a plastic grocery bag so that wet clothes can go back in it to return home in.
Date of Birth:
Payment for the camp weeks you reserve will be processed each Thursday prior to the week of attendance. If you need to change weeks, you
MUST NOTIFY our Account Manager, Casey Gutierrez via email at:
[email protected] before payment is processed. If email notification is received to change weeks
AFTER payment was processed, you may transfer payment to a different week, however there will be
NO REFUNDS if your child is a “NO SHOW” for the reserved week.We will let you know ahead of time when your child will need to wear their swimsuit. On swim days, you will need to supply them with a change of clothes & a towel inside of a plastic grocery bag so that wet clothes can go back in it to return home in.
MEDICAL INFORMATION & CONSENTS:
Virginia State Licensing requires a copy of your child’s most recent physical and immunizations, and proof of birth BEFORE a child can start. For your convenience, you may click the following link to print the “VA School Entrance Form” to have your child’s pediatrician complete as necessary:
Download School Entrance Form-
If you’re notified that your child is ill, you agree to arrange for yourself or one of your listed contacts to pick your child up within 1 hr. If your child or a member of your immediate household become ill or exposed to a Communicable Disease (CD), you agree to notify GraceAChild within 24 hrs.
In the event I cannot be reached, I authorize GraceAChild staff to act on my behalf for my child to receive emergency care, and if deemed necessary, arrange for emergency transport to the hospital of my choice.
IMPORTANT NOTE: In the event your child sustains an injury while in our care but is NOT transported to the hospital or doctor from GraceAChild’s center, you agree to contact the main office (540-382-9591) within 24 hrs should you decide at a later time to take your child to the hospital or doctor to be evaluated. Per Virginia State Licensing Standards, GraceAChild is mandated to report any medical treatment sought for the child’s injury after the child has been picked up from GraceAChild.
If medication needs to be administered, please click the link below to the Medicine Consent Form and have the pediatrician complete it. With the completed form, provide your child’s medicine in its original box to the director of the center. Describe any specific details in the box below.
Medication Consent      Food Allergy POA      Asthma POA
Product Supply & Labeling:
If you would like sunscreen applied to your child as needed, please provide products that are not expired, in their original box, and labeled with your child’s full name, and date of birth. Sunscreen is not required, but we highly recommend it especially between the months of April-October, and should be a minimum SPF 30.
Prescription Creams & Lotions and Possible Adverse Reactions:
If your child requires a prescription topical, we will need a Medicine Consent form from your pediatrician. If you know of any adverse reactions your child may have to sunscreen, please provide details in the box below.
PARENT/GUARDIAN INFORMATION:
If the primary parent (1st parent) has physical and/or legal custody of the child being enrolled, please be prepared to provide copies of legal court documents stating this. Please understand that if you do NOT provide this information and you choose NOT to include the secondary parent on this enrollment form, GraceAChild is legally bound to allow the secondary parent access to his/her child after we have properly identified them to do so. We can however alert you if the secondary parent is requesting to see the child.
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Cell Phone #
Cell Phone Provider’s Name
(Required for emergency communication as needed)
Valid Email Address Required
Va state licensing requires that we obtain your current employers address and phone # if you are currently employed.
Employer’s Name:
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Employer’s Phone #:
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Va state licensing requires that we obtain your current employers address and phone # if you are currently employed.
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Employer’s Phone #:
EMERGENCY CONTACTS & AUTHORIZED PICK-UPS:
Virginia State Law requires you to provide a minimum of 2 emergency contacts OTHER THAN the parent(s), that live within 1 hour of your child’s center.
If you are new to the area, we allow you 2 weeks to establish emergency contacts. It’s extremely important that you’re available by phone at all times while your child is in our care, especially during the 2 week period of establishing emergency contacts. If this information is not provided within 2 weeks of your child’s first day of attendance, your childcare services may be interrupted until this information is provided to the center.
Relation to Child:
Cell Phone #:
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Relation to Child:
Cell Phone #:
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You may add up to 2 additional people “OTHER THAN” yourself and your listed emergency contacts, who may pick your child up. This is optional.
Relation to Child:
Cell Phone #:
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Relation to Child:
Cell Phone #:
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If there are any unauthorized persons (other than parent/guardian without legal court documents) that you would like to restrict from your child, you may list them below.
PARENTAL AGREEMENTS:
We require a minimum 4 week written notice of withdrawal submitted to the center director in writing or via email. This gives us an opportunity to notify a family on our wait list that placement will be available on a given date, and also gives us an opportunity to say goodbye and prepare for your child’s departure. Failure to comply with this policy will result in a charge equal to the current weekly tuition rate for your child’s age group.
Example: If you give notice on the 1st and your child’s last day is on the 30th, this serves as a 4 week notice. However, if you give notice on the 15th and your child’s expected last day is the 30th, this is considered a 2 week notice and you will be charged an additional 2 weeks tuition to fulfill the agreement.
Pick-up after 6:30pm will result in a $10 fee for the first 5 minutes, and $5 a minute thereafter, no matter the reason! No Exceptions!
Our staff loves to share photo’s on Facebook of your children engaging in fun activities, the beautiful arts and crafts they’ve created, dancing and singing, or just being plain ol’ silly nilly’s. We encourage all families to Like our Facebook page to enjoy these photo’s. We do understand the immense responsibility that comes with proper etiquette and exposure of a child, especially on social media. Therefore, all photo’s are reviewed by the center director before posting to Facebook to ensure these standards are met for each child. No child’s name is ever included in any photo’s posted. If we would like to use an awesome photo of your child for advertising purposes, we will discuss this with you ahead of time and have you sign a separate permission form.
Parents will be informed ahead of time via; Email, Text Message, and/or Facebook, of scheduled closings for holidays or in the case of dangerous weather conditions. Please note that there will be no pause in tuition, discounts or credits issued for these closings. For inclement weather days, our center will do everything possible to be open for childcare without endangering our families or employees travel to and from the center. Should we close due to dangerous weather conditions, we will notify families asap.
* I understand that my child will not be allowed to play on any equipment unless my child meets the height and weight requirements.
* I understand that I am responsible for supervision while my child is playing on the playgrounds both inside and outside when I rent GraceAChild Academy USA for birthdays or special events.
* I acknowledge, release, and hold harmless the facilities, personel, and property of Graceway Ministries dba; GraceAChild Academy USA from a possible injury that could occur while my child is playing on the playground equipment.
* I release and hold harmless Graceway Ministries dba; GraceAChild Academy USA and it’s employees from liabilities and claims arising from my child’s participation on the playground equipment.
Grace-A-Child reserves the right to make changes to any policy, procedure, tuition rates, fees, or other processes and information in this parent handbook, rate sheets, or our enrollment forms without prior notice. We reserve this right to maintain licensing compliance, stability, and integrity of the programs, and for the safety and security of the children & families enrolled in our programs, and for the staff that our company employs. A copy of our handbook will be given to you upon receipt of enrollment.
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PAYMENT METHODS & POLICIES
GraceAChild reserves the right to make changes to any policy, procedure, tuition rates, fees, or other processes and information in the parent handbook, rate sheet, or our enrollment forms without prior notice. We reserve this right to maintain licensing compliance, stability, and integrity of the programs, and for the safety and security of the children & families enrolled in our programs, and for the staff that our company employs. A copy of our handbook will be given to you upon receipt of enrollment. The following policies are imposed to ensure consistency in all billing and collection processes with all families, and will be maintained without special regard.
* Unpaid Tuition & Late Payments ~ We require payment by auto debit ONLY. We DO NOT accept cash or checks. Payments are processed by automatic debit weekly on Friday’s prior to the week of attendance or monthly according to our billing schedule. Should payment be returned the first time unpaid by your creditor due to Non-Sufficient Funds, we will make a second attempt to collect funds on the following Monday. If payment is returned unpaid again, you will be charged a $35 NSF fee, notified via email, and payment in full will be expected no later than Wednesday. Unpaid balances after this time may result in additional fees or suspension of care until the balance is paid.
* Vendor Discount Qualifications: MCPS, Lewis Gale, and NRVCS Employees ~ Employment verification is required for all vendor employees before discounts are applied.
* Late Pick-Up Fees ~ Any child clocked out of our system at 6:31pm or later WILL BE CHARGED A FEE, NO MATTER THE REASON FOR BEING LATE! (ie; vehicle breakdown, personal emergency, heavy traffic or car accidents, illness, working later than usual, etc.) Fees are as follows: $10 for the 1st 5 min’s, and $5 a minute thereafter. Auto debit payers will have their account debited automatically. For further details, please see our “Late Pick-Up Policy”.
* Activity Fee ~ $75 per child, this fee must be paid before attending our Summer Camp. This fee is Non-Refundable!
* Registration Fee ~ 1 child=$25, 2 children=$50, per family=$75
All fees will be debited from your credit account.
Forms of payment we accept: Visa, Mastercard, Check Debit Card, or Checking Account Withdrawal (we do NOT accept Amex or Discover).
We accept: Visa, Mastercard, Check Debit Card, or Checking Account Withdrawal (ACH). (we do not accept Amex or Discover)
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If your card only shows the MM/YYYY, you may just enter the last date of the month in the “DD” space.
DEBIT AUTHORIZATION AGREEMENT:
Charges that may be automatically debited from your credit card or checking account will include the following as applicable:
* Registration & Activity fees (these fees are Non-Refundable)
* Weekly and monthly tuition charges
* Late payment fee of $35
* Late pick-up fees, $10 1st 5 min, $5 a min thereafter
* Non-Sufficient Funds fee of $35
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