ENROLLMENT APPLICATION

Childs Name ________________________________________________________________

First
Middle Initial
Last

Nickname ______________ Birthdate ____/____/_____

Age ______

Sex __________

Parents
Name of Mother ______________________________________________________________
First
Middle Initial
Last
______________________________________________________________________________
Address
City/State/Zip
Home Phone _____________________________ Cell Phone ________________________
Employment _________________________________________________________________
Address
City/State/Zip
Work Phone _______________________ Ext. _________ Work Hour(s) _______________
Name of Mother ______________________________________________________________
First
Middle Initial
Last
______________________________________________________________________________
Address
City/State/Zip
Home Phone _____________________________ Cell Phone ________________________
Employment _________________________________________________________________
Address
City/State/Zip

Work Phone _______________________ Ext. _________ Work Hour(s) _______________

Emergency Contacts
1. ________________________________________________________________________
Name
Phone
Relationship
Authorized to pick up child? Yes_________ No __________
2. ________________________________________________________________________
Name
Phone
Relationship
Authorized to pick up child? Yes_________ No __________
If parents are divorced, which parent has custody of child? ________________ N/A ______
Number of days per week for enrollment: M_____ T_____W _____ Th _____ F _____
Time Desired: AM __________

PM ____________

Full Day ________________

*A deposit of $35.00_ must accompany this application for registration fees.*

Parent(s) Signature(s)
____________________________________
Mother

______________________________________
Father

____________________________________
Date

______________________________________
Date

FOR CENTER USE ONLY

Date application received _____/______/_________
Date of childs enrollment _____/_______/_________
*Deposit is non-refundable unless the child is refused admission to BBDC Program*

Bright Beginnings Daycare Center, LLC

1103 Arlynn Lane, Virginia Beach, VA 23451
Business Phone: (757)965-9382 / Cell Phone: (757)672-6563

PHYSICAL EXAMINATION
(To Be Completed By Physician)
Childs Name ______________________________________ Date of Birth____/_____/_______
Parents or Guardians Name _____________________________________________________
Address ____________________________________________________Phone _____________
City _________________________________ State _________
Zip Code _______________
Height ______________________________ Weight _________________________________
Skin ________________________________ Head & Scalp ___________________________
Eyes ____________ Nose _______________ Lymph Nodes ___________________________
Ears _____________ (L) TM ______________ (R) TM _________________________________
Mouth: Teeth __________Gingiva _________ Palate __________________________________
Throat ________________ Neck ___________ Chest __________________________________
Heart ________________________________ BP ___________ Femoral Pule _____________
Lungs ________________________________ Abdomen ______________________________
Genitalia _____________________________ Rectum, anus ___________________________
Spine & Back __________________________ Extremities _____________________________
Neuromuscular ________________________ Gait ____________________________________
Urinalysis _____________________________
Vision: (R) Eye ______________ (L) Eye _______________________ Both ________________
Hearing: Normal _____________ Abnormal ___________________ Not tested ____________
Allergies _____________________________________________________________________

Type of
Immunizations

Number Given as of
Date of Examination

DTAP
_____/______/______
HBV
_____/______/______
Rubella/Rubeola (Measles/Mumps) _____/______/______
Influenza
_____/______/______
DTP or DT
_____/______/______
IPV
_____/______/______
PCV
_____/______/______
Rota
_____/______/______

Laboratory and Other Testings

(If Indicated)
Yes ______ No _______
____________________
___________________
____________________
Yes ______ No _______
____________________
____________________
____________________

Immunizations are up-to-date for age of child: Yes ___________ No _______________

I examined this child on (date) _____/______/______. I find him/her to be in good physical
condition, free from contagious and infectious diseases, and capable of participating in daycare
activities, except as noted below.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

_____________________________
Date

______________________________________
Physicians Signature

CHILD HEALTH AND PERSONAL

INFORMATION RECORD
Childs Name _________________________________________________________________
Nickname _______________________ Date of Birth ____/____/_____

Age __________

Mother (or Guardian) ___________________________________________________________

Father (or Guardian) ____________________________________________________________
If parents are divorced, please attach to this form documentary evidence of who has legal
custody. N/A ___________
Type of documentary evidence you/we are providing _________________________________
______________________________________________________________________________
Has your child had the following diseases or conditions?
Check () correct column (Communicable Disease Chart)
DISEASE
Measles/Mumps
RSV
Whooping Cough
Chicken Pox
Seizures
Scarlet Fever
Hand, Foot, & Mouth
Croup
Impetigo

YES

NO

DISEASE
Heart
Rheumatic Fever
Kidney
Diabetes
Infectious Hepatitis
Reye's Syndrome
Kawasaki
Brittle Bone
Ulcers

YES

NO

Does the child have frequent colds? If yes, explain ___________________________________

_____________________________________________________________________________
Tonsillitis?___________ Earaches?__________ Stomach aches?_________ Vomiting?______

Does the child run high fever easily? If yes, explain ___________________________________

Has the child had any serious accidents? If yes, explain ________________________________
______________________________________________________________________________
Does the child have allergies? If yes, explain _________________________________________

Does the child have an Epipen? Yes _________ No __________

Does the child have bedwetting issues? Yes ________ No ________
Is the child potty trained? Yes ___________ No _________
Does the child have a speech problem? If yes, explain _________________________________
______________________________________________________________________________
How would you evaluate your childs overall health? __________________________________
______________________________________________________________________________
______________________________________________________________________________
Does the child prefer to play alone _________________, or with playmates_______________?
Is the child afraid of pet? If yes, explain _____________________________________________
______________________________________________________________________________
What are your childs favorite indoor activities? ______________________________________
______________________________________________________________________________
What are your childs favorite outdoor activities? ____________________________________
_____________________________________________________________________________
List the TV programs the child is able to watch ______________________________________

Is the child right or left-handed? ___________________________________________________

Would you classify your child as a good ________ average _______, or poor ________ eater?
Does your child feed him or herself? Yes ________ No ________
Does the child nap during the day? _________ When? _________________________________
Can the child decide when to go to the bathroom, or is a reminder needed? _______________
______________________________________________________________________________
Words child uses for: Urination _________________ Bowel Movement ___________________
Does the child have any problems of which we should be aware of? _____________________

How would you describe your childs personality? ____________________________________

Brothers and Sisters of Child living at home:

Name _________________________________________ Age ___________ Grade __________
Name _________________________________________ Age ___________ Grade __________
Name _________________________________________ Age ___________ Grade __________
Name _________________________________________ Age ___________ Grade __________
Name _________________________________________ Age ___________ Grade __________
Are there any special family circumstances which may be a factor in your childs present
behavior (divorce, death, new baby, recent move, hospitalization, etc.)
Please explain _________________________________________________________________

______________________________________________________________________________

What concerns do you have about your childs present behaviors? ______________________

What are you doing about this concern? __________________________________________

What can BBDC do to assist in your effort? __________________________________________

In what ways would you like to see your child develop during this year at BBDC? ___________

Please add any comments that you feel will help us know your child better. Thank you very
much for your help. ___________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
_______________________________
Date

_____________________________________
Signature (Mother)

_______________________________
Date

_____________________________________
Signature (Father)

PICK-UP PERMISSION FORM

Note: I hereby give permission for my child, ______________________________________, to
Leave the Bright Beginnings Daycare center with the following persons named below. It is my
responsibility to notify the center, in writing, of any changes.

Name
__________________________________

Relationship
___________________________________

__________________________________

___________________________________

__________________________________

___________________________________

__________________________________
Date

___________________________________
Signature of Parent or Guardian

Name of person(s) who may NOT pick up the child

Name

Relationship

__________________________________

___________________________________

__________________________________

___________________________________

__________________________________

___________________________________

__________________________________
Date

___________________________________
Signature of Parent or Guardian

MEDICATION RELEASE
Medication must be in original container with childs name, medication name, and dosage
clearly marked.
Childs Name: __________________________________________________________________
Medication: ___________________________________________________________________
Amount: ______________________________________________________________________
Time: _________________________________________________________________________
Number of days: ________________________________________________________________
Number of doses: _______________________________________________________________

_________________________________
Date

____________________________________
Signature of Parent or Guardian
____________________________________
Director/Provider

DATE

NAME OF CHILD

MEDICATION

AMOUNT

TIME GIVEN STAFF SIGNATURE

ENROLLMENT CONTRACT
____________________________________________
Childs Name

will attend the

Bright Beginning Daycare Center

beginning ____________________
Day

________________________________.
Date

CHECK ONE: ________ Full time from: __________A.M. to __________P.M.

________ Part time from: __________A.M. to __________P.M.
PLEASE CIRCLE DAYS:

M T W TH F

The weekly tuition charge for your child will be ___________________________________.

All tuition charges are payable in advance and due on Friday of each week. Same advance
payment applies to those who paid bi-weekly.
*There will be $5 late fee for each 15mins past close of business...NO EXCEPTION!!*
The following fees will also apply based on your contract: Please initial next to each line.
_______They will be a $50 fee for any returned check
________ 3 or more days is consider a full week *NO EXCEPTION*
________ If your child has been sick for 3 or more days, a doctors note is required prior to your
child returning back to daycare.
________ If the child is going to be absent for more than one week, due to a vacation. Payment
for that week needs to be paid in order to hold a spot for your child.
_________ Once your child has been at Bright Beginnings Daycare for one year the paid week
vacation rule will NO LONGER apply.

________ If the child is absent for more than a week, due to a death in the family,
hospitalization, or some other extreme circumstance. There needs to be some sort of proof
showing such event occurred. Failure to provide such proof will result in you being charged for
the full week..NO EXCEPTION*
I have read and fully understand this contract, and agree to abide by Bright Beginnings Daycare
guidelines as mentioned above. I have received an exact copy of this contract for my own
records.
________________________________
Childs Name
_______________________________
Parent or Guardian (Mother)

__________________________
Parent or Guardian (Father)

_________________________________
Director/Provider
__________________________________
Date

PAID: __________________________

CASH: _________ CHECK#: __________

_______________________________
Date

_________________________________
Director/Provider

FOR CENTER USE ONLY

Date of Entrance _______________________
Date of Withdrawal ______________________

BRIGHT BEGINNING DAYCARE

POLICIES AND PROCEDURES

TRANSPORTATION
A transportation permission form must be signed for routine transportation and other times
children will be transported, such as for field trips, swimming and/or other activities away from
the home. Parents will be notified before children are transported.
If no one is home to receive a transported child when transportation to and from school or
home is provided, the child will be taken back to Bright Beginning Daycare and remain in care
until an authorized person is present to receive the child.
DISCIPLINE
At no time will a child be subjected to physical punishment or shaming, frightening or
humiliating methods be used, or any type of verbal abuse, threats, derogatory remarks, or
deprivation of a meal or any part of a meal be used. No person, including, but not limited to,
parents, guardians, or other family members may use such methods of discipline while on the
premises of Bright Beginnings Daycare. This type of behavior is unacceptable!!
EMERGENCY MEDICAL CARE
In the event of an emergency with your child, parents will be called, and if necessary the child
will be transported by ambulance to the nearest hospital.
ADMINISTRATION OF MEDICATION
No child will be given any medication, prescription or over-the-counter, unless the parent gives
written permission. Permission to Administer Medication forms are to be filled out each time
your child will need medicine to be administered. Prescription medication shall have the childs
name, name of medication, doctors name, name of pharmacy, prescription number, date, and
directions for administering. The medication must be in the original container as dispensed by
the pharmacy. Prescription medications WILL NEED to be accompanying by a written physician
note given Bright Beginnings Daycare permission to administer the medicine.

PARENT NOTIFICATION
Parents of any child who becomes ill or is injured while in care will be notified immediately of
any illness or injury requiring professional medical attention, or any illness which may not
require professional medical attention but which produces symptoms causing moderate
discomfort to the child, such as, but not limited to, any of the following: elevated temperature,
vomiting or diarrhea.
Special problems or significant developments will be communicated to the parents as soon as
they arise.

COMMUNICABLE DISEASE CHART

The current communicable disease chart of recommendations for exclusion of sick children
from the home and their readmission will be followed. Any cases or suspected cases of
notifiable communicable diseases listed on the disease chart will be reported to the local
county health department. If a child in care contracts a communicable disease, the parents of
all enrolled children will be notified of the occurrence either by a phone call, posted notice or a
written letter home.

CHILDREN WHO ARE ILL

Children may return to care 24 hours AFTER symptoms of the illness end which means if the
child is sent home with a fever, diarrhea, or vomiting they cannot return until they have been
symptom free for 24 hours without the aid of medications.
EMERGENCY PLANS
The following procedures will be followed in the circumstances listed below:
Fire: Get the children out of the house, meet at the designated safe place as far away from
house as possible, and conduct a head count to ensure all children are safely out. Call the fire
department, and call the parents.
Severe Weather: Remain calm. Move the children into a hallway or interior room away from
windows. In case of a tornado, or hurricane have the children place their heads between their
knees with their backs to the wall. Listen to the radio for weather updates. Call the parents and
if need be call 911.
Loss of Electrical Power: Remain calm. Call the power company to report power loss. If in hot
weather, open the windows, if possible. In cooler weather, put on warmer clothing or get
blankets out for the children. Call the parents if the power will be out for an extended period of
time.

Loss of Water: Have bottled water available for drinking purposes. Call the water department if
in the city. Call the plumber if in a rural area. If water will be out for an extended time, have
water available for hand washing and toileting purposes. Call the parents if the water will
remain out of service for an extended length of time.
Serious Injury to a Child: Call 911 ASAP. Keep the child calm and comfortable until medical
service arrives. Call the childs parents to report the injury ASAP. If child needs to be
transported right away parent will be notified of the hospital location. Bright Beginning
Daycare understands that this will be a very frustrated and sensitive situation. We/I cant leave
the other children alone to accompany your child to the hospital. Report the injury to Virginia
Department of Social Services.
Loss of a Child: Call 911 ASAP. Call the childs parent ASAP to report the loss. Keep the other
children calm. Call the neighbor to help assist in the search. Look in the house, yard, and
surrounding area. Report the loss of a child to Virginia Department of Social Services.
Death of a Child: Call 911 ASAP. Call the childs parents ASAP. Keep the other children calm.
Report the death to Virginia Department of Social Services.
PARENTAL ACCESS
Parents may visit the family day care home unannounced and at any time that their child is in
the care at Bright Beginnings Daycare. Any information requested by the parent concerning the
operation of the daycare home or the care of the child will be provided to parents. The
parent(s) will be provided daily communication (verbal/written) regarding the care of the child,
especially with infants, toddlers, and nonverbal children.
SOCIAL MEDIA
The posting of confidential and identifying information about the children, parents, or
staff at Bright Beginnings Daycare Center on social media (e.g., Facebook, MySpace, Twitter,
Instagram, etc.) is strictly prohibited. Anyone engaging in such behavior without consent of the
parent(s) will result in disciplinary action for the employee(s).

NOTIFICATION OF THE EXISTENCE OF FIREARMS IN THE HOME

Notification of the existence of a firearm in the family day care home will be communicated to
parents. Firearms shall be stored so they are not accessible to children.
NOTIFICATION OF CHANGES IN COMPOSITION OF HOUSEHOLD
Notification of any changes in the regular composition of the household will be given to
parents. Parents will be given notification of anyone regularly on the premises, including, but
not limited to, spouse, friend(s), relative(s), or significant other(s).

NOTIFICATION OF OTHERS PROVIDING CARE

Parents will be given notification of the names of any other caregiver, their responsibilities, and
the names of the persons who would be called upon in an emergency. Additional staff will
receive orientation regarding these rules; the provider's policies regarding discipline, injuries
and illnesses, and release of children; the provider's written plan for handling emergencies; and
appropriate information about any child's specific health needs.

HOUSEHOLD PETS
Notification of the existence of any pets or other animals residing in the home or on the
property of the family day care home will be given to parents. Pets in the home shall be
vaccinated in accordance with the requirements of the local county Boards of Health and
unconfined pets will not be permitted in child care areas when children are present. Proof of
vaccination will be kept on file in the home.
PROHIBITED SUBSTANCES
No person shall smoke, use tobacco or prohibited substances on the premises or in any vehicle
being used to transport children during operating hours.

INFANT SLEEP POSITION PRACTICES

Based on the risk factors of Sudden Infant Death Syndrome (SIDS) all infants will be
placed to sleep on the infants back unless the home has been provided a physicians
written statement authorizing another sleep position for that particular infant.
All infants will be placed to sleep on a firm, tight-fitting mattress in a sturdy and safe crib
with no pillows, quilts, comforters, bumper pads, sheepskins, stuffed toys, or other soft
items in the crib.
If a blanket is required for the comfort of the infant, the infants feet shall be placed at
the foot of the crib and the infant shall be covered with the blanket only to chest level
with the blanket tucked firmly under the crib mattress.
The infants sleeping area will be maintained within a temperature range of sixty-five
65 to eighty-five 85 degrees depending upon the season.
When an infant can easily turn over onto his stomach, staff shall continue to put the
infant to sleep initially on the infants back but allow the infant to roll over onto his or
her stomach as the infant prefers.
Positioning devices that restrict an infants movement in the crib will not be used unless
a physicians written statement authorizing its use is provided for that particular infant.

REQUIRED REPORTING
The Bright Beginnings Daycare is a mandated to report any suspected abuse, neglect, or
deprivation of a child. This means the law requires the provider to report any known or
suspected abuse, neglect, or deprivation to the Virginia Department of Social Services/Child
Protective Services.

AGES SERVED
Infant (0-12mths) Toddler (13mths2 yrs) Preschool (3 yrs 4 yrs) School Age (5yrs or older)
MONTHS OF OPERATION
January
February
July
August
DAYS OF OPERATION
Monday
Tuesday

March
September

April
October

Wednesday

May
November

Thursday

HOURS OF OPERATION
6 A.M. - 6 P.M.
MONDAY FRIDAY
CLOSING DATES
Bright Beginnings Daycare Center will be closed on the following holidays/dates:
LABOR DAY SEPTEMBER 2ND (Monday)
VETERAN DAY NOVEMBER 11TH (Monday)
THANKSGIVING DAY NOVEMBER 28th (Thursday)
DAY AFTER THANKSGIVING NOVEMBER 29TH (Friday)
CHRISTMAS EVE DECEMBER 24TH (Tuesday)
CHRISTMAS DAY DECEMBER 25TH (Friday)
NEW YEAR DAY JANUARY 1ST (Wednesday)

June
December

Friday

ADMISSION REQUIREMENTS
All necessary enrollment forms must be completed and returned prior to admission. It is the
parents responsibility to ensure all forms are updated immediately upon changes and at least
once a year. Upon arrival at Bright Beginning Daycare Center the parent, or adult dropping off
the child, must escort the child into the home and ensure that the provider is aware of their
presence.

FORMS NEEDED: Check ( ) each one after completion to insured you have everything.
Enrollment Application

Childs Health & Personal Information Record

Pick-up Permission Form
Enrollment Contract
Policies and Procedures Receipt of Acknowledgement Signed
Immunization Record
Permission to Administer Medication, if applicable

RECEIPT OF ACKNOWLEDGEMENT
The following policies and procedures are set forth to provide children with a clean, safe,
comfortable environment where they can play, learn, and grow with guidance and loving care.
These policies and procedures will be kept current, made available to parents, and used to
govern the operations of the Family Day Care Home along with the rules and regulations set
forth by Bright Beginning Daycare Center. These policies become effective upon acceptance by
the parent/guardian and the child care provider.

________________________________
Childs Name
_______________________________
Parent or Guardian (Mother)
_______________________________
Parent or Guardian (Father)
_________________________________
Director/Provider
__________________________________
Date