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Drop Zone Kids Registration Form

Drop Zone Kids Policies

Please Read Before Sigining

LOCATION AND CONTACT INFORMATION:

Address: 285 Pinehurst Ave, Suite 3c, Southern Pines, NC 28387

(910) 585-2094

Web: www.dropzonekids.com  

Email: Dropzonekids@gmail.com

Facebook: www.facebook.com/dropzonekidsdaycare/

Registration: We require every parent to register their child(ren) before receiving care in our facility. Contact information and emergency contact numbers are required as is the name and number of any other adults allowed to pick up children. We will not release your child to any person without your written permission. Parents can register their child in Drop Zone Kids by completing the registration form. Drop Zone Kids does not require a registration fee.

Payment: Payments will be due at time of checkout and will calculated and rounded up to 15 minute increments. For children remaining after closing hours there will be a charge per minute/per child of $1 until the child/children are picked up.

Fee/Family: $7.00/hour first child   $4.00/hour second child   $3.00/hour each additional child(ren). Other discounts and payment options available, see our website for details.Cash, check, Visa, MasterCard, American Express, Discover, and Apple Pay may be used to pay for child care fees. You will then have option to choose to have receipt emailed or texted to number/email of your choice. There is a $36.00 fee charged for payment checks returned by the bank. Returned checks will not be re-deposited. If at any future time the bank returns a parent’s check, all future fees payments must be made cash or with a credit card. All balances must be paid in full until childcare services are available to your family.

Arrival and Pick Up: We require that the parent, guardian, or an authorized representative must sign the child in upon arrival and out when leaving the childcare. The authorized representative must be approved by the parent or guardian, in writing, and must be 18 years old or older.

Arrival:

Announce your child’s arrival to a staff member
Sign your child in with a staff member
Allow your child to put his or her belongings away in designated cubby
Put hand sanitizer on child’s hands let child in facility

Pick Up:

Announce your arrival and the name of your child to a staff member. Locate and gather your child’s belongings. Double check everything is there before leaving (socks, pacifiers, cups, lunch boxes, wipes, etc). 

***DZK is not responsible for any lost items or belongings.
Sign child out with a staff member and pay fee for the day

Time Limit: Drop-in/short-term child care is defined by law in G.S. 110-86(2)(d)(d1) as a child care arrangement where care is provided while  parent, guardian, or an authorized representative participate in activities that are not employment related, and where the  parent, guardian, or an authorized representative are on the premises or otherwise easily accessible. Drop-in/short-term care child care would be used by parent, guardian, or an authorized representative who need care while they occasionally run errands or participate in leisure activities. The operation must be able to reach the parent, guardian, or an authorized representative by telephone, cell phone, or pager. The parent, guardian, or an authorized representative must be able to get back to the program within 15 minutes.  There is a 4-hour limit per day.

Snack and Meals: You are to provide a healthy snack or meal for your child while they are in our care. Please no items that contain peanuts. Please label snacks, cups and food items with your child’s name.  Also, please no candy or gum. We offer Goldfish and Animal Crackers at no extra cost for those without a snack. We also have filtered water always available.

Diaper Changing and Potty Training: Please bring children in a clean diaper and extra diapers and wipes. Diapers and wipes are not provided. Please bring a change of clothing for children not fully potty trained in case of an accident. 

Illness: Please do not send a child that has a fever, stomach ache, or any other signs of illness. 

Emergency Closures: We may be closed due to conditions beyond our control. In these circumstances, opening and closing times may change and times the facility may be closed for the day. We will do our best to keep the regular business hours and will post any changes on our Facebook page.

Holiday Closures and Early Closings: We will be closed on Easter, Thanksgiving, Christmas Eve and Christmas Day. There are some holidays we will close early, such as Memorial Day. Watch for any changes in hours on our Facebook page.

I give permission for my child to be given cardiopulmonary resuscitation (CPR) and first aid treatment by a qualified staff member of Drop Zone Kids. In the event I cannot be contactaced, I also give permission for my child to be transported by ambulance or aid car to an emergeny center for treatment.

 

I fully understand and agree to adhere to all policies above. By signing, I represent that I am the parent or legal guradian of each child designated on this registration form. I understand that the provision of child care contains risk of injury to persons and property, and that by signing the release below I, on behalf of myself, my spouse, or other guardians associated with each child noted on the registration form provided, do waive and release all rights, causes of action, and claims against Drop Zone Kids and its owners, employees, agents, and affiliates for any and all loss, expense, damage, or injuries suffered by my Child during the time my Child is at Drop Zone Kids’ facility, including the possible negligence of Drop Zone Kids, but excluding gross negligence and intentional misconduct. I understand that this Release will be kept on file at Drop Zone Kids and will remain in effect for this and all future visits my child may make to Drop Zone Kids.

First Child's Name

First Name*

Last Name*

Phone*
First Child's Date of Birth*
I certify that I am 18 years of age or older
First Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
First Child's Signature*
Second Child's Name

First Name*

Last Name*
Second Child's Date of Birth*
Second Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Third Child's Name

First Name*

Last Name*
Third Child's Date of Birth*
Third Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Fourth Child's Name

First Name*

Last Name*
Fourth Child's Date of Birth*
Fourth Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Fifth Child's Name

First Name*

Last Name*
Fifth Child's Date of Birth*
Fifth Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Sixth Child's Name

First Name*

Last Name*
Sixth Child's Date of Birth*
Sixth Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Seventh Child's Name

First Name*

Last Name*
Seventh Child's Date of Birth*
Seventh Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Eighth Child's Name

First Name*

Last Name*
Eighth Child's Date of Birth*
Eighth Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Ninth Child's Name

First Name*

Last Name*
Ninth Child's Date of Birth*
Ninth Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Tenth Child's Name

First Name*

Last Name*
Tenth Child's Date of Birth*
Tenth Child's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Child's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Other Parent/Guardian

First Name

Last Name

Contact Number
Authorized to Pick Up?*
Yes
No
Relationship to Child*
Pick-Up Authorization (not including yourself):

First Name Authorized Pick-up *

Last Name Authorized Pick-up *

Contact Number Authorized Pick-up *

2nd Authorized Pick-up First Name

2nd Authorized Pick-up Last Name

Contact Number 2nd Authorized Pick-up
At times we display pictures of the children playing and having fun. We would like your permission to photograph your child to use on our website, Facebook, or marketing materials. Please let us know what your wishes are regarding the situation:
Photos?*
Customer Source

How did you hear about us? *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Preferred Name
Medications?*
No
Yes
Allergies?*
No
Yes
Serious Medical Condition?*
No
Yes
Vision or Hearing Problems?*
No
Yes
Dietary Restrictions?*
No
Yes
Behavior Issues?*
No
Yes

If yes to any of the above, please explain:
Your Relationship to Child*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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