Registration & Enrollment Forms | Early Learning Centers of Broward | Serving Hollywood, Margate, Plantation, & Sunrise FL

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Fill in the enrollment form below to start the registration process for one of the 4 Early Learning Centers of Broward locations for your child.

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Enroll Your Child at an Early Learning Center of Broward School

Have You Already Toured the School?*
- Yes I have toured the school
- No, I would like to set a tour date
Thank you for your interest in our school! To schedule a tour, please fill out the contact form below and one of our staff members will contact you soon.

Which School are you applying for?*
- Hollywood
- Margate
- Sunrise
- Plantation
Child's Name*
First Last
Date of Enrollment*
Date Format: MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Birth Date*
Date Format: MM slash DD slash YYYY
Gender*
- Male
- Female
Preferred Name*
Email*
Referred By
Mother's Name*
First Last
Current Employer*
Work Phone
Cell Phone*
Home Phone*
Email*
Father's Name*
First Last
Current Employer*
Work Phone
Address*
Street Address Address Line 2 City ZIP Code
Cell Phone*
Home Phone*
Email*
Guardian*
First Last
Current Employer*
Work Phone
Business Address
Street Address Address Line 2
Home Address If not same as above
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Cell Phone*
Home Phone*
Email*
Child's Physician*
First Middle Last
May The Center Call Another Physician If Unable To Contact The Above*
Other Persons To Be Notified In Case Of Illness or Accident
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Persons Permitted To Remove Child
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Allergies or Diet Restrictions*

CHILD RELEASE FORM
For ( Child's Name)*
First
PLEASE NOTE THE FOLLOWING
1. It is legal for either parent to pick up the child unless we have a copy of the court order restricting visitation. The following parents have/do not have permission to pick up the child:
Father*
- Yes
- No
Mother*
- Yes
- No
2. Is there a court order restricting visitation of your child? If so, please list the person or persons restricted from picking up your child.
Name
First Last
Relationship to Child
Name
First Last
Relationship to Child
3. Think of a code word of 4 to 6 letters and list below to be kept on file at Early Learning Centers of Broward. When you are unable to get your child, call the center to notify the director. The director of the school will ask for this code word to verify your identity. Please keep this code word confidential. The authorized pick-up person will be asked to show a photo ID upon arrival at the center. The code word is utilized only when you are calling the Early Learning Centers of Broward to verify yourself with our staff. If necessary, you can change the code word and we will update our files to reflect your decision.
The Code Word to Be Used Is:
4. List persons permitted to pick up your child. Please keep their phone numbers current.
Name & Phone Number of Authorized Person*
Name & Phone Number of Authorized Person*
Name & Phone Number of Authorized Person*

FINANCIAL AGREEMENT
Financial Agreement for Child:*
Enter your child's name
First
1. Tuition payment is due in advance on Monday (and no later than Tuesday) of each week. After Friday, the child will be automatically disenrolled. 2. Any checks returned by the bank will have a $50.00 (Fifty dollars) charge assessed and check writing privileges will be revoked. 3. tuition payments made after Tuesday are considered late and a late fee of $30.00 (thirty dollars) will be assessed.4. Tuition may be paid in advance for more than one week.5. No tuition reimbursement or credit will be given for a child's absence, except for pre-approved vacations. 6. Infants and toddlers are permitted to take one week vacation during the year. Each preschool child is permitted to take two weeks' vacation during the year, (two weeks together or one week separate from the other). The year runs from your start date of registration, not the calendar year. Vacations or sick time runs Monday - Friday in the same week. Vacation time can also be used if your child is sick. Any additional time required for a vacation or sickness will require a RESERVATION FEE of 1/2 the weekly tuition in order to maintain your child's enrollment. 7. A two week written notice of withdrawal must be given to the office, or tuition will be charged until the child is properly withdrawn. Children that have been withdrawn from the program will be required to pay the Registration Fee at the point of reenrollment. 8. Registration fees are non-refundable.9. All delinquent accounts or returned checks will be submitted to the credit bureau and collection agency.
Parent Initials*
I affirm that I have read and understood the financial agreement and terms presented in this section. I agree to pay all fees and tuition assessed for my child on or before Monday of each week.

ADMISSIONS AGREEMENT
I have read, understand, and agree to comply with all procedures, policies, and conditions set forth in the handbook presented by Early Learning Centers of Broward.
Parent Initials*

ALTERNATE LUNCH SCHEDULE
Dear Parent,In Accordance with Broward County Child Care Ordinance, parents and the child care facility are urged to work cooperatively to assure that children are provided with nutritious snacks and meals where lunches are not provided by the facility. Please read the following carefully:
Parent Agrees to Provide a Nutritious:*
- I prefer to have the facility provide snacks and meals
- Mid-Morning Snack
- Lunch
- Mid-Afternoon Snack
(Please Check All That Apply)
If the parent has elected to have the facility provide nutritious options for snacks and meals, we will provide your child with breakfast, mid-morning snack, mid-afternoon snack, and lunch.
Parent Initials*
I affirm that I have read and selected the appropriate lunch schedule for my child.

Disciplinary Policy for (child's name)*
Early Learning Centers of Broward is committed to providing a safe and nurturing environment conducive to learning and growth for all of our students. We strive to ensure all of our children are set up for success regardless of their developmental level. Children will never be embarrassed or humiliated during the discipline process, nor will they be compared to other children. The following procedures are implemented in our facilities to correct and limit behavioral interruptions:1. We redirect the child or children involved to engage in alternative activities.2. We explain to each child why the behavior is unacceptable and model the correct behavior. This includes encouraging children to express their wants and emotions verbally rather than using physical means, as well as proper play with classroom materials.3. We may find it necessary to employ short-term restrictions on the use of specific play materials if the child repeatedly uses said material to harm other children. 4. In the event that the child's behavior becomes an extreme disruption to the classroom environment and none of the above procedures have corrected the behavior, the parent will be contacted to pick up the child for the remainder of the day. Any additional days for suspension can be applied if deemed necessary. We under
Parent Initials*
I affirm that I have read, understand and approve of the disciplinary procedures implemented at the Early Learning Centers of Broward, as stated in this section of the enrollment form.

PHOTO RELEASE
The Staff at Early Learning Centers of Broward take many pictures of the children throughout the year to illustrate, for you and them, the many activities in which the children are engaged. The children's names are not used when the pictures are displayed outside of Early Learning Centers of Broward.
I hereby*
- Grant
- Do Not Grant
The Staff at the Early Learning Centers of Broward the right to take photographs of my child. I authorize the Early Learning Centers of Broward, its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I have read and understand the photo release policy.*
Parent Initials

Medical Authorization for (Name of Child)*
MEDICATION
To ensure medication prescribed by your child's doctor is administered properly, Early Learning Centers of Broward asks that you follow these guidelines:Medication cannot be dispensed without a note from the child's physician. Verify the amount, any reaction and other information/instructions pertaining to the medication and make sure to inform your child's teacher. A medication mus be kept out for us to administer, MUST have your child's name clearly written on it. ALL medication must be kept out of the reach of children. Never mix medications with food or drinks in your child's lunch.
MEDICAL RELEASE FORM
In the event of an extreme medical emergency situation, as deemed by the Director or Acting Director, paramedics or medical personnel will be notified IMMEDIATELY to escalate medical attention for my child. All efforts will be made to notify me (or the guardian), immediately as well. Due to insurance regulations, injured or ill children must be transported to a hospital, when necessary, by paramedics or by ambulance. The cannot be transported by school bus or school personnel.Any expense for medical care or transportation involved with a medical emergency, which is an inherent risk, "WILL BE BORNE BY THE PARENT"The school will not be responsible for anything that may happen as a result of false information given at the time of enrollment.
I Hereby*
- Grant
- Do Not Allow
permission for my child to use all the play equipment and participate in all activities of the center.
List all Allergies*
List All Medical Conditions*
Name of Insurance Company*
Policy Number*
Group Number*
Hospital Preference*
Upon immediate need for medical attention for your child, the undersigned hereby gives consent to any x-ray examinations, anesthetics, medical or surgical diagnosis or treatment, and hospital care to be rendered to said minor upon the advice of a physician and/or surgeon licensed under the provisions of the Medical Practice Act.The undersigned further authorizes the above-named school to have the above named minor released into the custody of its representative, should hospital care no longer be required.This form is to be used ONLY in extreme EMERGENCY.
MEDICAL EXPENSE AGREEMENT
Due to the nature of our business, there is a degree of inherent risk of injury to the children. As in any other school environment or place of activity where children are involved these injuries do take place. Due to Insurance Regulations and a lawyer driven litigious society, this rlease is an agreement that ALL EXPENSES as the result of injuries, medical care, transportation, or legal fee involved with medical care or medical emergency "WILL BE THE RESPONSIBILITY BORNE BY THE PARENTS"
Signature of Parent or Legal Guardian*
Date*
Date Format: MM slash DD slash YYYY

Early Learning Centers of Broward

ENROLLMENT & FORMS

We’ve Simplified Our Enrollment Process!

Enroll Your Child at an Early Learning Center of Broward School

Other Persons To Be Notified In Case Of Illness or Accident

Persons Permitted To Remove Child

CHILD RELEASE FORM

PLEASE NOTE THE FOLLOWING

FINANCIAL AGREEMENT

ADMISSIONS AGREEMENT

ALTERNATE LUNCH SCHEDULE

PHOTO RELEASE

MEDICATION

MEDICAL RELEASE FORM

MEDICAL EXPENSE AGREEMENT

GET IN TOUCH

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Video Of Our Schools

We’ve Simplified Our Enrollment Process!

Enroll Your Child at an Early Learning Center of Broward School

Other Persons To Be Notified In Case Of Illness or Accident

Persons Permitted To Remove Child

CHILD RELEASE FORM

PLEASE NOTE THE FOLLOWING

FINANCIAL AGREEMENT

ADMISSIONS AGREEMENT

ALTERNATE LUNCH SCHEDULE

PHOTO RELEASE

MEDICATION

MEDICAL RELEASE FORM

MEDICAL EXPENSE AGREEMENT

GET IN TOUCH

CONTACT US VIA BELOW FORM

DOWNLOAD OUR APP

FOLLOW US ON FACEBOOK​

Video Of Our Schools

FOLLOW US ON FACEBOOK