Parent Understanding & Releases


Child's Name:

Parents / Guardians, please read and sign below stating that you understand and agree to the following statements.

  • Each child must have a current dental and physical examination including immunizations.
  • Current home, work, emergency addresses, and phone numbers must be accurate. Changes must be reported to the Family Advocate and Teacher.
  • Any program staff that suspects child abuse or neglect is required by law to make a report to Child Protective Services.
  • I agree to let CAPE transport my child, in the event of an emergency and to medical and dental appointments.
  • If your child has a chronic condition a care plan may be required before they can attend the program. Care plans must be updated yearly.
  • Child's illness or injury resulting in an absence of 3 or more program days may require a written statement from a health professional before the child may return. The program must be notified if the child will not be attending.
  • Minor injuries will be treated using first aid procedures and parent(s) or person picking child up will be notified.
  • I understand that any medication needed during school hours must contain child’s name, name of medication, dosage and time to be given and a medication log must be completed and signed by the parent / guardian.
  • CAPE will notify parents of any significant occurrences or problems that may affect the child, including possible exposure to communicable disease.
  • I give permission for my child to participate in the following:
    • Screenings for vision, hearing, blood pressure, and height / weight
    • Speech and Developmental Assessments
    • Social Emotional Assessment
    • Mental Health consultation (if necessary)
    • Lead Screening
    • Physical Exam
    • Dental Exam
  • Children will only be released to individuals listed on the emergency card with photo ID.
  • A staff person must be made aware of the child's arrival and departure and the child must be signed in and / or out.
  • CAPE uses a positive disciplinary approach with children. Children are informed of any inappropriate behavior and told what behavior is expected. They are then redirected to more constructive activities or allowed to spend some quiet time alone in a designated area in the classroom. Significant behavior concerns will be addressed with parents and documented in the child's file.
  • Every day, weather permitting (above 25 degrees and not raining), children will play outdoors, so children should be dressed for the weather. Children may remain indoors only with written direction from a health professional.
  • Children may get dirty while playing on the playground or experimenting with various art materials. Play clothes and appropriate shoes are strongly recommended. Because outdoor play is very active, dress shoes / boots with slick bottoms or open-toed sandals are generally less safe than tennis shoes. Each child must have a complete change of clothing at all times, to include socks and underwear.
  • I give CAPE irrevocable right and permission to take pictures or videos of me and my child(ren) and to
    • Copyright them in its own name or any other name it may choose
    • Use and re-use, publish or broadcast them in whole or in part in any medium for any purpose whatsoever, including but not limited to any trade, promotional or advertising purpose or in connection with any publication
    • Use my name and/or my children’s names in connection with the use of the photos or videos if CAPE so chooses.
  • I understand that CAPE must follow procedures for releasing any child’s information including missing child according to IC 12-17.2-4-18.5.
  • I understand that it is my responsibility to pick up my child at the center at the designated time. Being more than one hour late or multiple occurrences could result in meetings with staff to determine a plan of action, referral to CPS, or removal.
  • I understand and agree to follow all policies and procedures in the Parent Handbook. You may request additional handbooks from your Family Advocate.

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Signature Certificate
Document name: Parent Understanding & Releases
lock iconUnique Document ID: d0f3dcfda697b61dc4f9b3e12743bf243bce668c
Timestamp Audit
April 26, 2021 9:59 am CDTParent Understanding & Releases Uploaded by Joe Massaro - jmassaro@capeevansville.org IP 96.27.254.146