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Directions: The parent or guardian must fill out this form entirely and must return it to the facility no later than the morning of the child’s first day of enrollment. We will keep these forms on file in the facility and will be updated by the parent as needed by SMA to comply with Texas Childcare Licensing Minimum Standards. Forms must be completed in blue or black ink only.

This is the parent or guardian with whom we can get in contact with quickly in case of an emergency.

Must be other adult besides the parents or guardians

One may be the same as the emergency contact The authorized pick person must be other adults besides parents.

In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:

List any special problems that your child may have, such as environmental allergies, food intolerances, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months and from birth of the child. Any medication prescribed for long-term continuous use and any other information which caregivers and management should be aware of:

ADMISSION REQUIRMENTS: If your child does not attend pre-kindergarten or school away from Sunshine Montessori Academy, the following must be provided: Shot Record: We must receive an updated shot record to be placed in your child’s file every time your child gets a vaccination. If your child is not current with licensing standards, we will not be able to care for your child until they are up to date. Physician Statement: We have provided a physician form for your child’s doctor to fill out and sign to be placed in your child’s file. Form must be filled out completely and a stamp from the doctor’s office included in the designated spot. This form must be submitted within one week of your child’s first day of enrollment. Vision and Hearing Screening: The results of your child’s vision and hearing test must be submitted to be placed in their file once your child turns four years old.

Events, activities, programs, and facilities of the college are available to all without regard to race, color, marital status, sex, religion, national origin, disability, age as provided by law and in accordance with the Pipala Children Academy ’s respect for personal dignity.