Preschool in Campbell Union School District
A
Great Place to Start!
Phone:
408-341-7000 ext. 6378
School-age Childcare also available.
Three Easy Steps to Enroll
STEP
3. Complete
the Preschool Enrollment checklist and submit it to the Extension
Programs office.
Campbell
Union School District Preschool Program
Enrollment Document Checklist
AFTER YOU
RECEIVE CONFIRMATION OF PRESCHOOL PLACEMENT,
PLEASE COMPLETE
AND RETURN THE FOLLOWING DOCUMENTS.
□ A
copy of your child's Birth Certificate (or other official proof of birth date)
□ A copy of your child's up-to-date Immunization Record
(Your
child cannot start preschool unless all immunizations are complete. If your doctor determines that your child does not need a
TB test they need to complete the portion of the form on the Physician's
Report that states that no risk factors are present needs to be completed
by the doctor)
Please
fully complete the following forms:
□ Physician's
Report Form (LIC
701 Form PDF)
Every preschooler
must have proof of a physical examination completed within the year
prior to starting preschool. You fill out the top portion and your
child's doctor completes the bottom section. (A new form is not needed
for continuing families)
□ Child's Preadmission Health
History-Parent's Report (LIC
702 Form PDF)
□ Consent for Emergency Medical
Treatment (LIC
627 Form PDF)
□ Identification & Emergency
Information Form (LIC
700 Form PDF)
Please make
sure to fully complete Identification & Emergency Information form
with multiple people who can be contacted in case of an emergency and
who have your permission to pick up your child
□ Personal
Rights Form (LIC
613 A Form PDF)
Detach and
retain the top portion of the Personal Rights form for your records. Return
only the completed bottom section of the form. Use Capri, Marshall
Lane, Castlemont or Forest Hill Preschool as the Name of Child Care
Center for this and next form.
□ Notification
of Parent's Rights Form (LIC
995 Form PDF)
Detach and
retain the top portion of the Notification of Parent's Rights form
for your records. Return
only the completed bottom section of the form.
□ Preschool Agreement and
Family Handbook (Distributed
at Orientation)
□ Caregiver
Background Check Process Form (LIC
995 E Form PDF)
□
Please retain
this form. You do not have
to return the Caregiver Background Check Process form. It is for your
information only.
_____________________________________________________________________________________________________
For Office Use Only
This is a complete enrollment packet and all immunizations have been transferred to
blue card and are complete._____________________________ __________
Staff Signature Date
