Forms

The contract of service is a document signed by the parent/guardian, noting the days and hours service will be provided and the cost of service on a monthly basis. Families can choose a minimum of two full days a week up to five full days a week. The fee is based on enrollment terms and age of the child. The term of contract is for the entire school year.
Reservations for fall enrollment must be accompanied by $250 (check, money order or certified check). The ECEC reserves the right to disenroll a family for not following proper procedures to ensure they have an enrollment space for fall. As a student of UM-Dearborn, understand that you will have a hold on your account which means that you will not be able to register for classes or acquire your transcript until all outstanding fees and charges due to the University’s Early Childhood Education Center are paid.

Child Information Record Form

This form is provided through the State of Michigan Department of Licensing and Regulatory Affairs - Child Care Licensing.  A form is required for each child in the care of UM-Dearborn's ECEC.  This form must be updated if a change occurs or annually.  Emergency Contacts and Release of Child permission is included on this document.  Only individuals listed on this form are permitted to pick up the child.

Per Licensing, the form must be completed in its entirety.  If an answer is unknown or does not apply, type: "unknown" or "none".  

Policies & Agreements Form

The ECEC policies and agreements are updated annual with enrollment.  This include: Mutual Respect Policy; Permission for Developmental Assessment; Written Information Packet Documentation; Nutrition Policy; Audio-Visual Permission; Pesticide Notification; Parent Handbook/Health Policy Agreement; Parent Notification of Licensing Notebook; Consent and Waiver of Liability; Agreement to Financial Obligation.

Health Appraisal Form

The Health Appraisal and Immunization Records are required per Michigan State Licensing. This information is requested so that the school can work with the parent to meet the physical, intellectual and emotional needs of the child.  Parent/Guardian must complete Section I.  Section II must be completed by a doctor, nurse or dentist.  Section III may be certified by the transcription of information from the certificate of immunization.

The ECEC requires the health appraisal to be complete and on file within 30 days of starting school.  Physical must be done within the last year.  Records must be updated annually for children; date for updating is based upon current record on file.  

The immunization record must be turned in prior to the first day of school. If vaccinations are overdue, we require an updated immunization record showing the vaccines were administered OR an immunization waiver from your local health department.

Food Allergy Action Plan Form

The Food Allergy Action Plan form must be completed if your child has an allergy. Please fill out steps 1 and 2 on the form. We need to be aware of the severity of the allergy (airborne or only if ingested). If an EpiPen needs to be provided please mark the dosage on the sheet. If any other medication needs to be administered you must fill out the Medication Permission Form below.

Medication Permission Form

Petition Form

The Petition Form is utilized for change in schedule, exception to a policy and to withdrawal.  Please fill out the child's information, parent/guardian information with email along with the section(s) needed and the justification.  This can be turned into the front desk directly or email to [email protected].  Please allot for 30 days' notice when submitting a request.

The Early Childhood Program Administration Team will review the petition form.  Responses will be emailed with a copy of the petition and an adjusted statement if applicable.