Forms & Applications

ULA Enrollment Agreement

Completion of this agreement is required for enrollment. This form will enable us to better understand your child and meet his/her needs. Much of the information requested is necessary to comply with state child care licensing regulations.

Having trouble filling up the form? You can get this form here -> UCCLC Enrollment Agreement

Child’s Information
Family Information
Child Emergency Contact and Release Information (do not include parents/guardians/sponsors) Please notify the center if an Emergency Release Contact will pick up your child on a given day. Must be 16 years of age or older with a photo ID. [For the safety of your child, we request that all authorized pick-up persons with whom staff is not familiar provide a photo ID at the time of pick-up.]
Please notify the center if an Emergency Release Contact will pick up your child on a given day. Must be 16 years of age or older with a photo ID. [For the safety of your child, we request that all authorized pick-up persons with whom staff is not familiar provide a photo ID at the time of pick-up.]
Please notify the center if an Emergency Release Contact will pick up your child on a given day. Must be 16 years of age or older with a photo ID. [For the safety of your child, we request that all authorized pick-up persons with whom staff is not familiar provide a photo ID at the time of pick-up.]
Medical Information
Child’s Medical & Developmental History
Please attach care instructions from your physician for any of these illnesses.
Allergies (please list)
Allergies (please list)
Allergies (please list)
Allergies (please list)
Please attach care instructions from your physician for any life-threatening allergies.
Medical Information (continued)
Child’s Medical Care Provider
Child’s Insurance Provider
Above is a list of immunizations that your child may have received. Immunizations in checkmark are required by our state. [Check with your state requirements. You may do this at http://www.nnii.org/vaccineInfo/index.cfm#state Check any immunization below that is a requirement.]
Additional Medical Policies
Emergency Medical Authorization & Consent
Application of Sunscreen & Insect Repellant Authorization
Rate Agreement and Contract
Regular operating hours are Monday through Friday from 6:00 AM to 6:00 PM except closings for various holidays, and inclement weather as described in the Family Handbook. Please consult the current calendar for holidays. There is no reduction in tuition as a result of center closures. The procedure to notify families should severe weather or other conditions prevent the program from opening on time or at all will be announced on radio station ____107.7(WPRW-FM)_____. If it becomes necessary to close early, we will contact you or someone listed in the Emergency Contact and Release, and it will be your responsibility to arrange for your child’s early pick up.
Scheduled Attendance
Fee Policy (to be completed by staff; reviewed and initialed by the parent/guardian/sponsor after completion)
Private Employment Acknowledgement and Release
Media Release
Outside Excursions
Handbook Acknowledgement
Contract Approval
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