Latchkey Child Services: Where Students Get to Be Kids

Terms

By continuing, you agree to the following:

I will enroll in Tuition Express to avoid a $9.95 per payment charge.
The annual enrollment fee is non-refundable.
When my enrollment is processed, any enrollment fees due will be processed at that time.
Withdrawing or reducing my child’s number of programs requires two weeks’ written notice mailed to Latchkey’s main office.
I will be billed each week, regardless of how many days my child attends, except for weekly pre-scheduled school closures (Spring, Winter and other weekly breaks)
Weekly tuition is not pro-rated and is due even during unexpected school closures.
Weekly rates are established to be consistent across all weeks of school, regardless of number of days in specific weeks.
Payments are due one week in advance. $10 late payment fees will be assessed each week until my account is paid in full.
There is no additional charge for using miscellaneous intersession days, except for weekly pre-scheduled school closures. There is a $10 per day non-attendance fee if I fail to attend once I have reserved a space (does not apply to state assistance clients). Only clients signed up to attend weekly pre-scheduled school closures are billed for those weeks. The non-attendance fee applies here as well.

Differences for OKDHS State Assistance Enrollment

No enrollment fee.
Co-payments are due the first business day each month. $10 late payment fees are assessed each week until my account is paid in full.
Latchkey policy requires swiping the Access Oklahoma Card daily. All State clients can get an additional Card for any person they designate. You shall be charged for days not swiped and/or swipe errors resulting in non-payment by OKDHS including loss of monthly premiums due to such non-swipes or errors.

Consent*

I have read and agree to the above terms and conditions.

Client Number, If Known

Parent/Guardian's Name*

Relationship to Child*

Parent/Guardian's SSN*

Address*

Street Address Address Line 2 City State ZIP Code

Home Telephone*

Cell Telephone

Work Telephone

Email*

Mother/Guardian's Place of Employment

Best Contact Telephone Phone Number

Father/Guardian's Place of Employment

Best Contact Telephone Phone Number

Have you used Latchkey before?*

Yes

How many children are you enrolling?*

Please enter a number from 1 to 3.

If enrolling more than three, please complete the form again.

Child 1 Information

Child's Name*

Sex*

Date of Birth*

Age*

Date You Would Like Your Child to Begin Attending Latchkey*

Month

Day

Year

Name of person(s) with whom the child lives*

Tuition Type*

A scholarship application with income verification must be submitted to our office and approved before scholarship rates can be applied.

We must have OKDHS approval verification that your childcare benefit is assigned to the school you selected before attendance is allowed. Child must meet Latchkey’s attendance and swiping guidelines once enrolled.

Discounts will be applied once district employee verification has been received. (school badge, pay stub, letter from principal, etc)

School Information*

PM Program is held at Hayes Grade Center.

PM Program is held at Blanchard Elementary.

Program is held at Bridge Creek Elementary.

PM Program is held at Bridge Creek Elementary.

Program is held at Clara Reynolds Grade Center.

In case of emergency, if parent/guardian cannot be reached, list in order of preference person(s) to contact.

Name

Telephone

Immunization Record

A child 2 months of age or older cannot be admitted to a childcare facility unless the parent presents certification from a licensed physician or authorized representative of any state or local Department of health that such child has received or will receive immunizations at the medically appropriate time. Record the dates of immunizations below or upload a copy of the immunization record or Form FSS-TANF-1, Certificate of Exemption.

If you do not complete the immunization record below, take and give a copy of your child's immunization record directly to our Latchkey staff on your child's first day of attending Latchkey.

DTP/Dtap

List dates

Polio

List dates

HIB

List dates

Hepatitis A

List dates

Hepatitis B

List dates

MMR

List dates

Varicella(chicken pox)

List dates

Other

List dates

Upload Immunization Records

Upload a copy of the immunization record or Form FSS-TANF-1, Certificate of Exemption.

Drop files here or

Accepted file types: pdf, Max. file size: 100 MB.

Health Record

Child's physician or clinic

Physician or clinic telephone

Address

Street Address Address Line 2 City State ZIP Code

Does your child have any individual special needs involving routine care, behavior and guidance, communication or positioning? If yes, please describe:

Is your child allergic to any foods, medications, etc.? If yes, please describe:

Describe any special precautions for diet, medication, or activity, if applicable:

I give permission to the child care staff to consult with health and child development professionals regarding my child's needs.*

Yes

Transportation Permissions*

I do not give permission for my child to be transported.

I give permission for my child to be transported.

If you give permission for your child to be transported, check where you allow your child to be transported.

to the nearest medical facility, if a medical emergency occurs and I cannot be reached.

on field trips

to and from school

to and from home

other

Please specify:*

Persons having permission to pick up child (include yourself and your spouse if applicable:

Name

Telephone

Child 2 Information

Child's Name*

Sex*

Date of Birth*

Month

Day

Year

Age*

Date You Would Like Your Child to Begin Attending Latchkey*

Month

Day

Year

Name of person(s) with whom the child lives*

Tuition Type*

A scholarship application with income verification must be submitted to our office and approved before scholarship rates can be applied.

Discounts will be applied once district employee verification has been received. (school badge, pay stub, letter from principal, etc)

School Information*

PM Program is held at Hayes Grade Center.

PM Program is held at Blanchard Elementary.

Program is held at Bridge Creek Elementary.

PM Program is held at Bridge Creek Elementary.

Program is held at Clara Reynolds Grade Center.

In case of emergency, if parent/guardian cannot be reached, list in order of preference person(s) to contact.

Name

Telephone

Immunization Record

If you do not complete the immunization record below, take and give a copy of your child's immunization record directly to our Latchkey staff on your child's first day of attending Latchkey.

DTP/Dtap

List dates

Polio

List dates

HIB

List dates

Hepatitis A

List dates

Hepatitis B

List dates

MMR

List dates

Varicella(chicken pox)

List dates

Other

List dates

Upload Immunization Records

Upload a copy of the immunization record or Form FSS-TANF-1, Certificate of Exemption.

Drop files here or

Max. file size: 100 MB.

Health Record

Child's physician or clinic

Physician or clinic telephone

Address

Street Address Address Line 2 City State ZIP Code

Does your child have any individual special needs involving routine care, behavior and guidance, communication or positioning? If yes, please describe:

Is your child allergic to any foods, medications, etc.? If yes, please describe:

Describe any special precautions for diet, medication, or activity, if applicable:

I give permission to the child care staff to consult with health and child development professionals regarding my child's needs.*

Yes

Transportation Permissions*

I do not give permission for my child to be transported.

I give permission for my child to be transported.

If you give permission for your child to be transported, check where you allow your child to be transported.

to the nearest medical facility, if a medical emergency occurs and I cannot be reached.

on field trips

to and from school

to and from home

other

Please specify:*

Persons having permission to pick up child (include yourself and your spouse if applicable):

Name

Telephone

Child 3 Information

Child's Name*

Sex*

Date of Birth*

Month

Day

Year

Age*

Date You Would Like Your Child to Begin Attending Latchkey*

Month

Day

Year

Name of person(s) with whom the child lives*

Tuition Type*

A scholarship application with income verification must be submitted to our office and approved before scholarship rates can be applied.

Discounts will be applied once district employee verification has been received. (school badge, pay stub, letter from principal, etc)

School Information*

PM Program is held at Hayes Grade Center.

PM Program is held at Blanchard Elementary.

Program is held at Bridge Creek Elementary.

PM Program is held at Bridge Creek Elementary.

Program is held at Clara Reynolds Grade Center.

In case of emergency, if parent/guardian cannot be reached, list in order of preference person(s) to contact.

Name

Telephone

IMMUNIZATION RECORD

If you do not complete the immunization record below, take and give a copy of your child's immunization record directly to our Latchkey staff on your child's first day of attending Latchkey.

DTP/Dtap

List dates

Polio

List dates

HIB

List dates

Hepatitis A

List dates

Hepatitis B

List dates

MMR

List dates

Varicella(chicken pox)

List dates

Other

List dates

Upload Immunization Records

Upload a copy of the immunization record or Form FSS-TANF-1, Certificate of Exemption.

Drop files here or

Accepted file types: pdf, Max. file size: 100 MB.

Health Record

Child's physician or clinic

Physician or clinic telephone

Address

Street Address Address Line 2 City State ZIP Code

Does your child have any individual special needs involving routine care, behavior and guidance, communication or positioning? If yes, please describe:

Is your child allergic to any foods, medications, etc.? If yes, please describe:

Describe any special precautions for diet, medication, or activity, if applicable:

I give permission to the child care staff to consult with health and child development professionals regarding my child's needs.*

Yes

Transportation Permissions*

I do not give permission for my child to be transported.

I give permission for my child to be transported.

If you give permission for your child to be transported, check where you allow your child to be transported.

to the nearest medical facility, if a medical emergency occurs and I cannot be reached.

on field trips

to and from school

to and from home

other

Please specify:*

Persons having permission to pick up child (include yourself and your spouse if applicable):

Person

Telephone

Agreement and Signature

Consent*

I AGREE to adhere to the policies and procedures as outlined in the Latchkey Parent Handbook available on-line at www.Latchkey.us and the notice regarding payments available here.

Consent*

I UNDERSTAND that I must read these policies.

Consent*

I GIVE PERMISSION for my child(ren) to participate.

Consent*

MEDICAL EMERGENCY: If a medical emergency occurs and I cannot be reached, I hereby authorize the person in charge at the program site to transport my child to the nearest hospital, medical facility, and/or call my family physician or 911.

Signature*

Today's Date*

Month

Day

Year

CAPTCHA

Enrollment Form

Terms

By continuing, you agree to the following:

Differences for OKDHS State Assistance Enrollment

Child 1 Information

Immunization Record

Health Record

Child 2 Information

Immunization Record

Health Record

Child 3 Information

IMMUNIZATION RECORD

Health Record

Agreement and Signature

Latchkey Child Services Inc.