Common use of Medications Clause in Contracts

Medications. No medicine, including Tylenol or Advil, will be dispensed from the office without parental consent—see form on page 48 of the handbook. If a child needs to take medication during the day, the medication should be properly labeled with the child’s name, name of the medication and times that the medication should be administered. Medication issued by a doctor’s prescription must be in the original bottle with the original dispensation label attached. The medication should be given to the teacher at the beginning of the day and he/she will send it to the office where it will be kept. If a child has any severe allergies, the parent should send a note that includes instructions and/or medications needed in case of an allergic reaction. First Aid First aid supplies, such as bandages, alcohol, peroxide, and Caladryl are available in the office. In case of serious injury, parents are called immediately. Occasionally accidents may occur in which immediate hospitalization is necessary. In this case, pupils are sent to the hospital, but the school does not assume any responsibility for expenses incurred for hospitalization. Hospital authorities are immediately informed that the school is in no way responsible and that they must look to the parents of the patient for their fee. Uniform Requirements/Dress Code Academic performance, attitude, and personal appearance often go hand-in-hand. Canton Academy would like to set a tradition of students being known for their neat and appropriate appearance. For information concerning CA approved uniforms see Schoolwide Uniform Requirements/Dress Code in the General section above. Book Bag Policy No book bags with wheels. Parties and Invitations Room mothers will be in charge of parties but will contact the teacher in advance. Please do not send party invitations to school to be passed out unless all children in your child’s class (or all boys for a BOY party/all girls for a GIRL party) receive an invitation. Telephone Usage Students are not permitted to use the phone unless it is an emergency. In the event that a student must phone a parent, the office telephone must be used. NO cell phones will be used between the hours of 8:00 a.m. and 3:00 p.m. Any social activity must be arranged before coming to school. Visitors Visitors to Canton Academy are always welcome. They should check in at the office upon arrival to receive a visitor badge and then returned it upon leaving. Exceptions will be made at pep rallies and programs.

Medications. No medicine, including Tylenol or Advil, will be dispensed from the office without parental consent—see form on page 48 of the handbook. If a child needs to take medication during the day, the medication should be properly labeled with the child’s name, name of the medication and times that the medication should be administered. Medication issued by a doctor’s prescription must be in the original bottle with the original dispensation label attached. The medication should be given to the teacher at the beginning of the day and he/she will send it to the office where it will be kept. If a child has any severe allergies, the parent should send a note that includes instructions and/or medications needed in case of an allergic reaction. First Aid First aid supplies, such as bandages, alcohol, peroxide, and Caladryl are available in the office. In case of serious injury, parents are called immediately. Occasionally accidents may occur in which immediate hospitalization is necessary. In this case, pupils are sent to the hospital, but the school does not assume any responsibility for expenses incurred for hospitalization. Hospital authorities are immediately informed that the school is in no way responsible and that they must look to the parents of the patient for their fee. Uniform Requirements/Dress Code Academic performance, attitude, and personal appearance often go hand-in-hand. Canton Academy would like to set a tradition of students being known for their neat and appropriate appearance. For information concerning CA approved uniforms see Schoolwide Uniform Requirements/Dress Code in the inthe General section above. Book Bag Policy No book bags with wheels. Parties and Invitations Room mothers will be in charge of parties but will contact the teacher in advance. Please do Party invitations will not send party invitations to school to be passed out at school unless all children in your child’s class (or all boys for a BOY party/all girls for a GIRL party) receive an invitation. Telephone Usage Students are not permitted to use the phone unless it is an emergency. In the event that a student must phone a parent, the office telephone must be used. NO cell phones will be used between the hours of 8:00 a.m. and 3:00 p.m. Any social activity must be arranged before coming to school. Visitors Visitors to Canton Academy are always welcome. They should check in at the office upon arrival to receive a visitor badge and then returned it upon leaving. Exceptions will be made at pep rallies and programsarrival.

Medications. No medicineThe provider will not administer any medication, including Tylenol over the counter or Advilprescription, will without a parent(s)'or physician's written authorization. Authorization may be dispensed from the office without parental consent—see form on page 48 of the handbookgiven by phone in certain emergency situations. If a child needs prescription medications are to take medication during be administered by the day, the medication should be properly labeled with the child’s name, name of the medication and times that the medication should be administered. Medication issued by a doctor’s prescription provider they must be in the original bottle pharmaceutical container with the original dispensation label attachedfull dosage and frequency instructions. The label must have the child's, xxxxxxxx's, and physician's name and the physician's telephone number. A medication should administration form will be given provided. Records and Supplies A child cannot start care until these forms are received. Under Fairfax County law parent(s) are required to provide a copy of the teacher child's immunization records signed by the doctor. These records must be kept on file at the beginning day care facility at all times and updated each year. A signed Emergency Authorization for Medical Treatment form must also be signed and kept on file. Xxxxx's certificate needs to be viewed by the provider. CHILD’S RECORD Page 1 of 2 o INDICATE “N/A” IF THE INFORMATION IS NOT APPLICABLE. o THE COMPLETED FORM MUST BE KEPT IN THE CHILD’S RECORD AND THE FIRST PAGE UPDATED ANNUALLY. o THE INFORMATION IN THIS FORM IS REQUIRED BY FAMILY DAY HOME STANDARD 22 VAC 00-000-00. Child’s Full Name Nickname Sex Birth date Street Address City State Zip First Day of Attendance Last Day of Attendance If Child Attends School, Give Name of School Grade EMERGENCY INFORMATION Allergies and intolerance to food, medications, or other substances. Actions to take in emergency situation. Chronic Physical Problems/Diseases; Pertinent Development Information; Special Accommodations Needed; Special Instructions to Provider Father’s Full Name Phone Employer Father’s Employer’s Address (Street Address) Father’s Work Phone Father’s Home Address (Street Address) (enter “Same” if address is the same as the child’s) Mother’s Full Name Phone Employer Mother’s Employer’s Address (Street Address) Mother’s Work Phone Mother’s Home Address (Street Address) (enter “Same” if address is the same as the child’s) Child’s Physician Office Address (Street Address) Phone City State Zip Name of Child’s Medical Insurance Policy Number Name of Emergency Contact if Parent(s) Cannot Be Reached Street Address Phone City State Zip Name of Emergency Contact if Parent(s) Cannot Be Reached Street Address Phone City State Zip Person(s) Authorized to Pick Up Child (Appropriate custodial paperwork (custody order or other court order) shall be attached if a parent is not allowed to pick up the child) Parent Signature (Valid for One Year) Date 1st yr. review Parent Signature Date 2nd yr. review Parent Signature Date 3rd yr. review Parent Signature Date VDSS MODEL FORM - FDH Page 2 of 2 CHILD’S RECORD PROOF OF AGE AND IDENTITY (must be obtained from parent within 7 business days of child’s first day of attendance) Names & Locations (City and State) of Previous Child Day Care Programs & Schools Attended Place of Birth Birth Date Birth Certificate Number Date Issued Proof of Age Other Than Birth Certificate* Date Documentation Viewed Person Viewing Documentation NOTIFICATION OF LOCAL LAW ENFORCEMENT AGENCY (if parent does not provide proof of child’s age and identity within 7 business days of child’s first day of attendance) Date of Notification Name of Agency Notified Name of Individual Notified *Proof of age and identity may be verified by viewing one of the following: certified birth certificate; birth registration card; notification of birth, i.e., hospital, physician, or midwife record; passport; copy of the placement agreement or other proof of the child's identity from a child placing agency; original or copy of a record or report card from a public school in Virginia; signed statement on letterhead stationery from a public school principal or other designated official that assures the child is or was enrolled in the school; or child identification card issued by the Virginia Department of Motor Vehicles. The child’s Emergency Information and the Emergency Medical Authorization must be made available to a physician, hospital, or emergency responders in the event of a child's illness or injury. Date Signature of Parent I authorize to obtain immediate care and consent to emergency medical Name of Licensed Provider procedures upon, the hospitalization of, the performance of necessary diagnostic tests upon, the use of surgery on, and/or the administration of drugs to if an emergency occurs and I cannot be located immediately. Name of Child It is also understood that this agreement covers only those situations which are true emergencies and only when I cannot be reached. Otherwise I expect to be notified immediately. EMERGENCY MEDICAL AUTHORIZATION ADDITIONAL DOCUMENTS REQUIRED FOR CHILD’S RECORD Immunization and Physical Examination Record Form MCH213 F (signed by physician, physician’s designee, or health official) Information for Parents (signed by parent) Policy for the Administration of Medications (signed by parent) Liability Insurance Declaration (signed by parent) Provisions of the Home's Emergency Preparedness and Response Plan (signed by parent) As Applicable: General Permission for Regularly Scheduled Trips (signed by parent) Special Field Trip Permission (signed by parent) Medication Consent (signed by parent) *Valid for 10 days unless also signed by physician Permission to Participate in Swimming or Wading Activities (signed by parent) *Valid for one year Injury Record(s) If Child with Special Needs is in Care: Staffing Recommendation for a Child with Special Needs (signed by parent, provider, and Licensing representative) Individual Health Care/Special Needs (signed by licensed health care professional) 032-05-0011-07- eng PARENT/PROVIDER CHILD CARE AGREEMENT This child care is dedicated to providing the highest quality care in child care to your family. Below is a description of the policies that help create a well run program. Please read this description so we can discuss any areas of concern. Your signature signifies that you have read, understand, and accept these policies. Day Care Schedule For your convenience the day care is open from 7:00 am to 6:00 pm, Monday through Friday. Your child will attend from to on . The day care is also available evenings, weekends, overnight and heholidays as needed/she will send it requested, at additional fees. We have an Open Door Policy where parents and legal guardians are welcome to visit their children at anytime while their children are in our care. Fees and Payment Payment is to be made on Wednesday in advance of the office where it week of care. Payments not receive by this day will be keptcharged a 10%, ten percent, late fee. If The agreed upon fee for child care is per week / day / hour. Additional fee of $35 will be charged for returned checks. All overtime and /or extra fees will be due on the next scheduled payment day. Continued returned checks and/or late/missed payments may result in a child has new payment policy or termination of services (without notice) at the provider's discretion. Overtime is any severe allergiestime services are provided outside the agreed upon schedule. Late arrival or early departure does not offset overtime charges. The overtime charges are as follows: • $10.00 per hour after 6pm. Additional fees will be charged for evening, weekend, overnight, and holiday care. They are as follows: • Holidays and Weekends, between the hours of 7:00 am to 6:00 pm - $ • Before 7:00am or after 6:00pm - $10.00 per hour • Overnight - $ 2 weeks security deposit is due at the time or registration. The deposit will be refunded upon termination as long the required 2 weeks notice is given on Wednesday on due payments in advance. Otherwise, the parent should send a note that includes instructions and/or medications needed in case of an allergic reaction. First Aid First aid supplies, such as bandages, alcohol, peroxide, and Caladryl are available in the officedeposit will be retained. In case of serious injurycancellation of this agreement the deposit will not be refunded. The security deposit will only be refunded if the child has been enrolled and attended daycare. If the child spot has been reserved and the child does not attend daycare, parents are called immediately. Occasionally accidents may occur in which immediate hospitalization is necessarythe security deposit will not be refunded and the deposit will be retained. In this casecase of cancellation of their agreement the deposit will not be refunded. Holiday Leave The care provider takes paid leave on all recognized county holidays. Here is a list of those days: • New Year's Eve (Half Day) • New Year's Day • Xxxxxx Xxxxxx Xxxx Xx. Day • Washington's Day • Memorial Day • Independence Day • Labor Day • Columbus Day • Veteran's Day • Thanksgiving (Thursday and Friday) • Christmas Eve (Half Day) • Christmas Day Provider Paid Vacations The child care provider will be on vacation every Christmas holidays and one week in summer (2nd week of August). Child care will be run by its staff. Supplies will be provided as indicated (check if applicable): Parent Provider Toys Toys Diapers/Wipes Homemade Food/Milk Food/Formula Crib Sheets, pupils are sent to the hospitalBlankets Crib Car seat 3 sets clothes/bedding Other: Diaper rash cream Other: 1 box Kleenex tissues Hand wipes Daily Routine The provider will maintain a consistent routine of activities, but the school does not assume any responsibility for expenses incurred for hospitalization. Hospital authorities are immediately informed that the school is in no way responsible and that they must look to the parents of the patient for their fee. Uniform Requirements/Dress Code Academic performance, attitudemeals, and personal appearance often go hand-in-handrest times. Canton Academy would like to set A sample of a tradition typical day's activities for older toddlers and preschoolers is: • A.M. ◦ Arrival, free play ◦ Breakfast for early arrivals ◦ Free play/ outside play ◦ Hand washing, snack ◦ Music and movement ◦ Reading/writing/coloring ◦ Hand washing, lunch ◦ Quiet transition time • P.M. ◦ Rest ◦ Snack ◦ Outdoors play ◦ Free play/fine motor ◦ Creative arts ◦ Departure Free play indicates child choosing form of students being known for their neat activity from the variety offered. Infants and appropriate appearanceyoung toddlers have naps and feedings based on individual schedules. For information concerning CA approved uniforms see Schoolwide Uniform Requirements/Dress Code in the General section above. Book Bag Policy No book bags with wheels. Parties Acceptable Behavior and Invitations Room mothers Guidance Corporal punishment or humiliating means of discipline will be in charge of parties but will contact the teacher in advance. Please do not send party invitations to school to be passed out unless all children in your child’s class (or all boys for a BOY party/all girls for a GIRL party) receive an invitation. Telephone Usage Students are not permitted to use the phone unless it is an emergency. In the event that a student must phone a parent, the office telephone must be used. NO cell phones This includes, but is not limited to spanking, slapping, and/or shaking. The provider will redirect or offer strategies for guidance based on the child's developmental stage. Compliance with Regulations • Permit/license – Provider will operate child care with a valid country permit or state license. • Reporting of child abuse or neglect – Provider will comply with mandate to report all suspected child abuse or neglect. Communication and Parental Involvement Parent(s) are always welcome to come and visit their children. Open and continuous communication between the parent(s) and the provider is essential to the child's well being. The provider will keep the parent(s) advised on the child's behavior and progress as well as observed changes in behavior in the child. The parent(s) should discuss any questions they have about the program or the child's activities and behavior during the day. Also, the parent(s) should inform and/or discuss with the provider problems the child is experiencing at home or situations that may affect the child. The parent(s) are encouraged to participate in the child's activities by visiting and attending celebrations. Termination Parent(s) and provider will give the other party a minimum of 2 weeks notice on Wednesday. Provider will receive regular compensation in lieu of notice. This compensation will be used between taken out of the hours initial deposit. Agreement I/we Have read and understand this agreement, and agree to comply with it. I/we enter into agreement with Great Expectations Childcare for the care of 8:00 a.m. and 3:00 p.m. Any social activity must be arranged before coming to schoolmy/our child . Visitors Visitors to Canton Academy are always welcomeThis agreement shall remain in effect until a two weeks written notice is provided by either party or until it is replaced by another contract. They should check in at the office upon arrival to receive a visitor badge and then returned it upon leaving. Exceptions This agreement will be made at pep rallies and programs.reviewed and/or revised one year from the date if this agreement or earlier if needed. Parent 1 Signed Date Print Name Address Parent 2 Signed Date Print Name Address Provider Signed Date VDSS MODEL FORM – FDH Page 1 of 2

Medications. No medicine, including Tylenol or Advil, will be dispensed from the office without parental consent—see form on page 48 of the handbook. If a child needs to take medication during the day, the medication should be properly labeled with the child’s name, name of the medication and times that the medication should be administered. Medication issued by a doctor’s prescription must be in the original bottle with the original dispensation label attached. The medication should be given to the teacher at the beginning of the day and he/she will send it to the office where it will be kept. If a child has any severe allergies, the parent should send a note that includes instructions and/or medications needed in case of an allergic reaction. First Aid First aid supplies, such as bandages, alcohol, peroxide, and Caladryl are available in the office. In case of serious injury, parents are called immediately. Occasionally accidents may occur in which immediate hospitalization is necessary. In this case, pupils are sent to the hospital, but the school does not assume any responsibility for expenses incurred for hospitalization. Hospital authorities are immediately informed that the school is in no way responsible and that they must look to the parents of the patient for their fee. Uniform Requirements/Dress Code Academic performance, attitude, and personal appearance often go hand-in-hand. Canton Academy would like to set a tradition of students being known for their neat and appropriate appearance. For information concerning CA approved uniforms see Schoolwide Uniform Requirements/Dress Code in the General section above. Book Bag Policy No book bags with wheels. Parties and Invitations Room mothers will be in charge of parties but will contact the teacher in advance. Please do Party invitations will not send party invitations to school to be passed out at school unless all children in your child’s class (or all boys for a BOY party/all girls for a GIRL party) receive an invitation. Telephone Usage Students are not permitted to use the phone unless it is an emergency. In the event that a student must phone a parent, the office telephone must be used. NO cell phones will be used between the hours of 8:00 a.m. and 3:00 p.m. Any social activity must be arranged before coming to school. Visitors Visitors to Canton Academy are always welcome. They should check in at the office upon arrival to receive a visitor badge and then returned it upon leaving. Exceptions will be made at pep rallies and programsarrival.

Medications. No medicine, including Tylenol or Advil, will be dispensed from the office without parental consent—see form on page 48 of the handbook. If a child needs to take medication during the day, the medication should be properly labeled with the child’s name, name of the medication and times that the medication should be administered. Medication issued by a doctor’s prescription must be in the original bottle with the original dispensation label attached. The medication should be given to the teacher at the beginning of the day and he/she will send it to the office where it will be kept. If a child has any severe allergies, the parent should send a note that includes instructions and/or medications needed in case of an allergic reaction. First Aid First aid supplies, such as bandages, alcohol, peroxide, and Caladryl are available in the office. In case of serious injury, parents are called immediately. Occasionally accidents may occur in which immediate hospitalization is necessary. In this case, pupils are sent to the hospital, but the school does not assume any responsibility for expenses incurred for hospitalization. Hospital authorities are immediately informed that the school is in no way responsible and that they must look to the parents of the patient for their fee. Uniform Requirements/Dress Code Academic performance, attitude, and personal appearance often go hand-in-hand. Canton Academy would like to set a tradition of students being known for their neat and appropriate appearance. For information concerning CA approved uniforms see Schoolwide Uniform Requirements/Dress Code in the General section above. Book Bag Policy No book bags with wheels. Parties and Invitations Room mothers will be in charge of parties but will contact the teacher in advance. Please do not send party invitations to school to be passed out unless all children in your child’s class (or all boys for a BOY party/all girls for a GIRL party) receive an invitation. Telephone Usage Students are not permitted to use the phone unless it is an emergency. In the event that a student must phone a parent, the office telephone must be used. NO cell phones will be used between the hours of 8:00 a.m. and 3:00 p.m. Any social activity must be arranged before coming to school. Visitors Visitors to Canton Academy are always welcome. They should check in at the office upon arrival to receive a visitor badge and then returned it upon leaving. Exceptions will be made at pep rallies and programs.