Instructions

1. Student's photograph* must be taken and saved to the tablet or electronic device used to complete this application BEFORE entering any information into the form below. 
2. A photograph* of the signed and dated Influenza Virus DCF Form, complete with Parent/Guardian and Child's Name, must be taken and saved to the tablet or electronic device used to complete this application BEFORE entering any information into the form below. (Note: The upload button for the Influenza Virus DCF Form will appear on the last page of the application.)
3. Any additional photographs* or documents* that need to be uploaded to this form must be saved to the tablet or electronic deviced used to complete this application BEFORE entering any information into the form below. Additonal photographs include photographs of persons not allowed to pick up student; additional documents include court orders or letters from doctor(s). 

*Uploaded photographs must be less than 10 MB.

** Required fields are marked with an (*). 

**If you marked “None of the above” on the previous question, please skip the next two questions and sign below. If you marked any other answer on the question above, please answer the remaining questions and sign below.

Is there any person NOT allowed to pick up your child?

In case of emergency, Excel Kids Academy staff will call 911 and contact the parent/legal guardian and/or emergency contacts listed with Excel Kids Academy. 

Please provide Excel Kids Academy with medical personnel contact information to obtain emergency medical care if warranted. 

PRIVACY RIGHTS

PERMISSION TO EVALUATE PROGRAMS AND TRACK STUDENT PROGRESS

FLORIDA CHILD CARE STANDARDS AND STATUTES

• Section 402.3125(5), F.S., requires that parents receive a copy of the Child Care Facility Brochure, "Know Your Child Care Facility" (CF/PI 175-24). 
• Section 65C-22.006(3)(c)2., F.A.C., requires that parents are notified in writing of the disciplinary practices used by the child care facility. 

Please read and check each program expectation, and initial each section. By initialing and signing at the bottom, you agree to comply with each requirement.

Your signature below indicates that you have received the items on the Florida Child Care Standards & Statutes, all of the program expectations and that the information on this enrollment form is complete and accurate. 

I give my permission for this information to be submitted to 21st Century for program quality and evaluation purposes. The 21st Century provides funding for the program.