Enrollment Form

Whether a returning scholar or new applicant, please complete
the following Registration modules.

Section 1: Parent & Scholar Demographics

Form 1 of 4: Application for Admission
       Form 2 of 4: Admissions Information
       Form 3 of 4: Media/Medium Release Form
       Form 4 of 4: Enrollment Agreement Form

Section 2: Health Records

Form 1 of 3: Health & Medication Records
Form 2 of 3: Authorization for Dispensing Medication
Form 3 of 3: Emergency Medical Release Form

Section 3: Nutritional Services

Form 1 of 1: Instructions for CACFP Meal Benefit Income Eligibilty Form

Section 4: Authorization for Pick-Up

Form 1 of 1: Authorization of Pick-Up Form

Section 5: Parents of Infants Only for Pick-Up

Form 1 of 1: Instructions for Operational Policy on Infant Safe Sleep

Step 1 of 10 - In Section 1: Parent & Scholar Demographics
Form 1 of 4

Application for Admission
2020-2021 Academic Year
Grade Applying For
Student Classification?
- New Scholar
- Returning Scholar
Student Member Classification?
- Member of IBOC Church
- Non-Member of IBOC Church
CCA Participant
Scholar Last Name
Scholar First Name
Scholar Middle Name
Scholar Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Scholar Home Telephone Number
Scholar Gender
- Male
- Female
Scholar Birth Date
MM slash DD slash YYYY
Scholar Birthplace
City State
Names of All Siblings Attending and/or Applying:
Citizenship?
Ethnic Origin
Church Parent(s) Currently Attend(s):
Your Current Pastor's Name:
Name of Current School (New Applicants Only)
Telephone Number of Current School
Address of Current School
Street Address Address Line 2 City State ZIP Code
Fax Number of Current School
Who has legal custody of the student?
Financial responsibility for the student will be assumed by:
If different from Father and/or Mother, please provide the following information:
Name
First Last
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone Number
Cell Phone Number
Work Phone Number
Is a language other than English spoken in your home?
If yes, what language or languages?
It is understood that this application is made subject to the terms of admission and tution rates in effect at the time of entrance to the University of Dreams at IBOC.
Signature of Parent/Custodial Guardian
Date
MM slash DD slash YYYY
Section 1: Form 1 of 4

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Media/Medium Release for Students Unversity of Dreams at IBOC
Schools and/or media often photograph and/or interview students as part of coverage of positive school events. To allow that to happen we need to have the permission of the students' parents or guardians.

By checking the "grant permission" box and signing your permission on this form, you are indicating that you are agreeing to allow the use of such materials related to advertisement of the University of Dreams at IBOC School System, Children's College and /or Leadership and Arts Academy.

Please review, check and sign below.
I hereby (please check one (1) box)
- grant permission
- do not grant permission
for the _____________________ (school name) to publish, copyright, or use all films, photographs, computer-generated imagery, printed and spoken words in which my son/daughter is included, whether taken by staff, students or others. I further agree that the school can use these photographs, videography and words for any exhibitions, billboards, displays, web pages, social media and publications, without reservation or compensation, for the present 2020-2021 school year and summer months, if needed; for media materials related to the University of Dreams at IBOC School System, Children’s College and/or Leadership Academy.
Student Name
First Last
Teacher Name
Class/Age Group
Parent/Guardian Name
Signature of Parent/Guardian
Date Signed
MM slash DD slash YYYY
Section 1: Form 3 of 4

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Enrollment Agreement Form
1. I agree to pay the Registration and Educational Fees at the time of enrollment and understand that these fees are due annually thereafter.

2. I agree to pay the full tuition fee each week (every Monday), with no deductions for absences or holidays, to ensure my child’s space in the College AND/OR, I agree to pay the full tuition each month (first Monday of the month), with no deductions for absences or holidays, to ensure my child’s space in LAA.

3. The University of Dreams is open Monday-Friday, 8:00 a.m.- 3:00 p.m. Should it be absolutely necessary to close because of severe weather conditions, the closing will be announced on local television, radio stations, text and/or email.

4. In case of withdrawal of my child from the University of Dreams, I agree to follow all stated and written procedures to include notifying the Director and participating in a tuition meeting with the Finance Dept. to finalize my account.

5. Legal authorities may be contacted for children left at U of D for more than one hour after closing.

6. This agreement is subject to change in part or in whole by the University of Dreams with an appropriate amount of written notice.

7. In order for my Non-Member Rate to change or be adjusted to a Member Rate, I must be an active member of the Inspiring Body of Christ Church ministry for at least six months
Name of Enrolling Child or Children
For Office Use Only
1. Registration Fee $55.00/$80.00 Multi-child (CC) / $75.00 (LAA)

2. Educational Fee _______________

3. Weekly Tuition CC _______________

4 . Monthly Tuition LAA _______________
I certify that I have read, received, and understand the above information. I have also reviewed the parent handbook online. I agree to the financial terms and conditions of the fee schedule listed above.
Section 1: Form 4 of 4

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Authorization for Dispensing Medication
Parent(s)/Guardian(s), Signing this form designates permission, upon verbal contact between parent & Health Assistant and/or parent & Directors ONLY, to The University of Dreams to administer non-prescription medication to your child according to the established directions on the label. I understand that this releases The University of Dreams (U of D), Children’s College and Leadership and Arts Academy, Pastor Rickie G. Rush, Inspiring Body of Christ Church (IBOC), its affiliates, successors, directors, officers, employees, and representatives of all liability. I give my permission to The University of Dreams Health Assistant or Directors to administer the listed non-prescription medications to my child, listed below, in hopes of decreasing his/her temperature/symptoms until I or my authorized pick up person(s) arrive(s).
PARENT’S AUTHORIZATION
Name of Child to Receive Medicine

Name of Non-Prescription Medication
Children's Tylenol
Children's Motrin
Children's Benadryl
None Should be Administered
Name of Non-Prescription Medication

Prescription Medication

Disposition of Leftover Medication (Office Use Only)

Prescribing Physician

Prescription No.

Expiration Date
MM slash DD slash YYYY

Dosage

When to Give

Continue Medication Until (date)
MM slash DD slash YYYY

NOTE: Medication must be in its original container and labeled with your child’s name and the date medication is left at the facility. Medication can only be administered in amounts according to the label directions.
Signature-Parent or Guardian
Date
MM slash DD slash YYYY

Section 2: Form 2 of 3

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Emergency Medical Release Form
This document is to state that any University of Dreams at IBOC School Leaders, Educators and Staff (in that order) have permission to seek medical care in the event it should become necessary, during any phase of the school activity where my child ____________________________ is involved

Physician's Name

Office Phone
Mother’s Name

Mother’s Cell

Work Number

Father’s Name

Father’s Cell

Work Number

Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact
Name

Relationship to Child

Cell

Work Number

Name

Relationship to Child

Cell

Work Number

Parent Signature
Date
MM slash DD slash YYYY

Section 2: Form 3 of 3

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Instructions for CACFP Meal Benefit Income Eligibilty Form
Authorization for Emergency Care Action Plan

The following form contains critical but sensitive information that must be filled out thoroughly.
Open and Download Form Here
Open
Please follow these steps:

Click the “Open” link on the right side of this page. The form will open in a new browser tab.

Download, print, and fill out form (requires a signature).

Save completed form as a digital file (photo jpeg, scan to PDF, etc.).

Return to this section and use the upload button to attach your digital file to your application.
Attach the Form and Upload Here

Drop files here or

Max. file size: 16 MB, Max. files: 1.

Section 3: Form 1 of 1

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Authorization of Pick-Up Form
The following individuals are authorized to pick up:
Name Relationship to Child Cell Phone Number Work Number

The following individuals are authorized to pick up:
Name Relationship to Child Cell Phone Number Work Number

The following individuals are authorized to pick up:
Name Relationship to Child Cell Phone Number Work Number

Parent(s) Signature
Date Signed
MM slash DD slash YYYY

Persons not listed will not be able to pick up the above child without proper notification to the Director(s) and proper identification of the additional pick-up person.
Section 4: Form 1 of 1

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Operational Policy on Infant Safe Sleep
All staff, substitute staff and volunteers at the University of Dreams will follow these safe sleep recommendations of the American Academy of Pediatrics (AAP) and the Consumer Product Safety Commission (CPSC) for infants to reduce the risk of Sudden Infant Death Syndrome/Sudden Unexpected Infant Death Syndrome (SIDS/SUIDS):

Always put infants to sleep on their backs unless you provide an Infant Sleep Exception form 2710 signed by the infant's health care professional [§746.2427 and §747.2327].

Place infants on a firm mattress, with a tight fitting sheet, in a crib that meets the CPSC federal requirements for full size cribs and for non-full size cribs [§746.2409 and §747.2309].

For infants who are younger than 12 months of age, cribs should be bare except for a tight fitting sheet and a mattress cover or protector. Items that should not be placed in a crib include: soft or loose bedding, such as blankets, quilts, or comforters; pillows; stuffed toys/animals; soft objects; bumper pads; liners; or sleep positioning devices [§746.2415 and §747.2315]. Also, infants must not have their heads, faces, or cribs covered at any time by items such as blankets, linens, or clothing [§746.2429 and §747.2329].

Do not use sleep positioning devices, such as wedges or infant positioners. The AAP has found no evidence that these devices are safe. Their use may increase the risk of suffocation [§746.2415 and §747.2315].

Ensure that sleeping areas are ventilated and at a temperature that is comfortable for a lightly clothed adult [§746.3407(10) and §747.3203(10)].

If an infant needs extra warmth, use sleep clothing (insert type of sleep clothing that will be used, such as sleepers or footed pajamas) as an alternative to blankets [§746.2415 and §747.2315].

Place only one infant in a crib to sleep [§746.2405 and §747.2305].

Infants may use a pacifier during sleep. But the pacifier must not be attached to a stuffed animal or the infant’s clothing by a string, cord, or other attaching mechanism that might be a suffocation or strangulation risk [§746.2415 and §747.2315].

If the infant falls asleep in a restrictive device other than a crib (such as a bouncy chair or swing, or arrives to care asleep in a car seat), move the infant to a crib immediately, unless you provide an Infant Sleep Exception form 2710 signed by the infant's health care professional [§746.2426 and §747.2326].

Our child care program is smoke-free. Smoking is not allowed in Texas child care operations (this includes ecigarettes and any type of vaporizers) [§746.3703(d) and §747.3503(d)].

Actively observe sleeping infants by sight and sound [§746.2403 and §747.2303].

If an infant is able to roll back and forth from front to back, place the infant on the infant's back for sleep and allow the infant to assume a preferred sleep position [§746.2427 and §747.2327].

Awake infants will have supervised “tummy time” several times daily. This will help them strengthen their muscles and develop normally [§746.2427 and §747.2327].

Do not swaddle an infant for sleep or rest unless you provide an Infant Sleep Exception form 2710 signed by the infant’s health care professional [§746.2428 and §747.2328].

DFPS values your privacy. For more information, read our privacy policy at: http://www.dfps.state.tx.us/policies/privacy.asp.
This policy is effective on:
MM slash DD slash YYYY

Child's name:

Signature Parent
Date signed:
MM slash DD slash YYYY

Section 5: Form 1 of 1
Name
This field is for validation purposes and should be left unchanged.

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Enrollment Form

Step 1 of 10 - In Section 1: Parent & Scholar Demographics Form 1 of 4

Application for Admission

2020-2021 Academic Year

Admissions Information

Media/Medium Release for Students Unversity of Dreams at IBOC

Enrollment Agreement Form

Health & Medication Records

Authorization for Dispensing Medication

Emergency Medical Release Form

Instructions for CACFP Meal Benefit Income Eligibilty Form

Authorization of Pick-Up Form

Operational Policy on Infant Safe Sleep

Step 1 of 10 - In Section 1: Parent & Scholar Demographics
Form 1 of 4