{"id":3614,"date":"2020-07-29T13:39:34","date_gmt":"2020-07-29T17:39:34","guid":{"rendered":"https:\/\/youngmindsinmotion.com\/?page_id=3614"},"modified":"2025-01-22T01:41:33","modified_gmt":"2025-01-22T06:41:33","slug":"enroll","status":"publish","type":"page","link":"https:\/\/youngmindsinmotion.com\/es\/enroll\/","title":{"rendered":"Inscribirse"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3614\" class=\"elementor elementor-3614\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b494433 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"b494433\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b6fe91f\" data-id=\"b6fe91f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a37cfbd elementor-widget elementor-widget-text-editor\" data-id=\"a37cfbd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h1 style=\"color: #fff; text-align: center; text-transform: uppercase;\">Enroll<\/h1><p>All families will be interviewed for child placement after enrolling.<br \/>One week free trial.<br \/>We are accepting vouchers (HRA, ACS)<br \/>Private Tuition \u2013 Reasonable Rates!!<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-63d02eb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"63d02eb\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-cc5d045\" data-id=\"cc5d045\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fdd2b7b elementor-widget elementor-widget-wp-widget-gform_widget\" data-id=\"fdd2b7b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wp-widget-gform_widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel='stylesheet' id='gforms_reset_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/formreset.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_datepicker_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/datepicker.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_formsmain_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/formsmain.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_ready_class_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/readyclass.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_browsers_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/browsers.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<script type=\"text\/javascript\" src=\"https:\/\/youngmindsinmotion.com\/wp-includes\/js\/dist\/dom-ready.min.js?ver=f77871ff7694fffea381\" id=\"wp-dom-ready-js\"><\/script>\n<script type=\"text\/javascript\" src=\"https:\/\/youngmindsinmotion.com\/wp-includes\/js\/dist\/hooks.min.js?ver=4d63a3d491d11ffd8ac6\" id=\"wp-hooks-js\"><\/script>\n<script type=\"text\/javascript\" src=\"https:\/\/youngmindsinmotion.com\/wp-includes\/js\/dist\/i18n.min.js?ver=5e580eb46a90c2b997e6\" id=\"wp-i18n-js\"><\/script>\n<script type=\"text\/javascript\" id=\"wp-i18n-js-after\">\n\/* <![CDATA[ *\/\nwp.i18n.setLocaleData( { 'text direction\\u0004ltr': [ 'ltr' ] } );\n\/* ]]> *\/\n<\/script>\n<script type=\"text\/javascript\" id=\"wp-a11y-js-translations\">\n\/* <![CDATA[ *\/\n( function( domain, translations ) {\n\tvar localeData = translations.locale_data[ domain ] || translations.locale_data.messages;\n\tlocaleData[\"\"].domain = domain;\n\twp.i18n.setLocaleData( localeData, domain );\n} )( \"default\", {\"translation-revision-date\":\"2026-03-27 23:59:20+0000\",\"generator\":\"GlotPress\\\/4.0.3\",\"domain\":\"messages\",\"locale_data\":{\"messages\":{\"\":{\"domain\":\"messages\",\"plural-forms\":\"nplurals=2; 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                <div class='gform-body gform_body'><ul id='gform_fields_21' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_21_566\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_566'>LinkedIn<\/label><div class='ginput_container'><input name='input_566' id='input_21_566' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_21_566'>Este campo es un campo de validaci\u00f3n y debe quedar sin cambios.<\/div><\/li><li id=\"field_21_86\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_86'>Referred By<\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_21_86' type='text' value='' class='medium'   tabindex='1'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_91\" class=\"gfield gfield--type-select gfield--input-type-select gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_91'>How did you hear about the school?<\/label><div class='ginput_container ginput_container_select'><select name='input_91' id='input_21_91' class='medium gfield_select' tabindex='2'    aria-invalid=\"false\" ><option value='Word of mouth' >Word of mouth<\/option><option value='Driving by and seeing the school' >Driving by and seeing the school<\/option><option value='The bus' >The bus<\/option><option value='Online AD' >Online AD<\/option><\/select><\/div><\/li><li id=\"field_21_557\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_557'>Location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_557' id='input_21_557' class='large gfield_select' tabindex='3'   aria-required=\"true\" aria-invalid=\"false\" ><option value='556 Richmond Rd, Staten Island, NY' >556 Richmond Rd, Staten Island, NY<\/option><option value='44 Victory Blvd, Staten Island, NY' >44 Victory Blvd, Staten Island, NY<\/option><option value='1966 1st Avenue, East Harlem, NY' >1966 1st Avenue, East Harlem, NY<\/option><\/select><\/div><\/li><li id=\"field_21_29\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Program Selection<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_29'><li class='gchoice gchoice_21_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='Pre-School - Private - Ages 2-5'  id='choice_21_29_1' tabindex='4'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_29_1' id='label_21_29_1' class='gform-field-label gform-field-label--type-inline'>Pre-School - Private - Ages 2-5<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_29_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.2' type='checkbox'  value='After School - Up to age 12'  id='choice_21_29_2' tabindex='5'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_29_2' id='label_21_29_2' class='gform-field-label gform-field-label--type-inline'>After School - Up to age 12<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_29_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.3' type='checkbox'  value='DOE 3k'  id='choice_21_29_3' tabindex='6'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_29_3' id='label_21_29_3' class='gform-field-label gform-field-label--type-inline'>DOE 3k<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_29_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.4' type='checkbox'  value='DOE 4k'  id='choice_21_29_4' tabindex='7'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_29_4' id='label_21_29_4' class='gform-field-label gform-field-label--type-inline'>DOE 4k<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_29_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.5' type='checkbox'  value='Infants and 1 Year Olds'  id='choice_21_29_5' tabindex='8'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_29_5' id='label_21_29_5' class='gform-field-label gform-field-label--type-inline'>Infants and 1 Year Olds<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_15\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Child&#039;s Information<\/h2><\/li><li id=\"field_21_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Child&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_1'>\n                            \n                            <span id='input_21_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_21_1_3' value='' tabindex='10'  aria-required='true'     \/>\n                                                    <label for='input_21_1_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_21_1_6' value='' tabindex='12'  aria-required='true'     \/>\n                                                    <label for='input_21_1_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_21_12\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_12'>Nickname<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_21_12' type='text' value='' class='medium'   tabindex='14'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_11\" class=\"gfield gfield--type-select gfield--input-type-select gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_11'>Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_21_11' class='medium gfield_select' tabindex='15'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/li><li id=\"field_21_10\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_21_10' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_21_10_1_container'><label for='input_21_10_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>MM<\/label><select name='input_10[]' id='input_21_10_1' tabindex='16'  aria-required='true'  ><option value=''>MM<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_21_10_2_container'><label for='input_21_10_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>DD<\/label><select name='input_10[]' id='input_21_10_2' tabindex='17'  aria-required='true'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_21_10_3_container'><label for='input_21_10_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>AAAA<\/label><select name='input_10[]' id='input_21_10_3' tabindex='18'  aria-required='true'  ><option value=''>AAAA<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_21_449\" class=\"gfield gfield--type-number gfield--input-type-number gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_449'>Child&#039;s Age<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_449' id='input_21_449' type='number' step='any' min='1'  value='' class='small' tabindex='19'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_21_449\" \/><div class='gfield_description instruction ' id='gfield_instruction_21_449'>Por favor, escribe un n\u00famero mayor o igual a <strong>1<\/strong>.<\/div><\/div><\/li><li id=\"field_21_34\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Enrollment Date<\/label><div id='input_21_34' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_21_34_1_container'><label for='input_21_34_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>MM<\/label><select name='input_34[]' id='input_21_34_1' tabindex='20'  aria-required='false'  ><option value=''>MM<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_21_34_2_container'><label for='input_21_34_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>DD<\/label><select name='input_34[]' id='input_21_34_2' tabindex='21'  aria-required='false'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_21_34_3_container'><label for='input_21_34_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>AAAA<\/label><select name='input_34[]' id='input_21_34_3' tabindex='22'  aria-required='false'  ><option value=''>AAAA<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_21_389\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_389'>SSN<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_389' id='input_21_389' type='text' value='' class='medium'   tabindex='23'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_2\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Primary Home Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_21_2' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_21_2_1_container' >\n                                        <input type='text' name='input_2.1' id='input_21_2_1' value='' tabindex='24'   aria-required='true'    \/>\n                                        <label for='input_21_2_1' id='input_21_2_1_label' class='gform-field-label gform-field-label--type-sub '>Direcci\u00f3n<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_21_2_3_container' >\n                                    <input type='text' name='input_2.3' id='input_21_2_3' value='' tabindex='25'   aria-required='true'    \/>\n                                    <label for='input_21_2_3' id='input_21_2_3_label' class='gform-field-label gform-field-label--type-sub '>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_2.4' id='input_21_2_4' value='New York'\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_21_2_5_container' >\n                                    <input type='text' name='input_2.5' id='input_21_2_5' value='' tabindex='26'   aria-required='true'    \/>\n                                    <label for='input_21_2_5' id='input_21_2_5_label' class='gform-field-label gform-field-label--type-sub '>C\u00f3digo Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_2.6' id='input_21_2_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_21_35\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_35'>Home Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_35' id='input_21_35' type='tel' value='' class='medium' tabindex='27'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Child&#039;s Primary Residence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_27'>\n\t\t\t<li class='gchoice gchoice_21_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Mother'  id='choice_21_27_0' tabindex='28'   \/>\n\t\t\t\t<label for='choice_21_27_0' id='label_21_27_0' class='gform-field-label gform-field-label--type-inline'>Mother<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='Father'  id='choice_21_27_1' tabindex='29'   \/>\n\t\t\t\t<label for='choice_21_27_1' id='label_21_27_1' class='gform-field-label gform-field-label--type-inline'>Father<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_27_2'>\n\t\t\t\t<input name='input_27' type='radio' value='Both'  id='choice_21_27_2' tabindex='30'   \/>\n\t\t\t\t<label for='choice_21_27_2' id='label_21_27_2' class='gform-field-label gform-field-label--type-inline'>Both<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_27_3'>\n\t\t\t\t<input name='input_27' type='radio' value='Guardian'  id='choice_21_27_3' tabindex='31'   \/>\n\t\t\t\t<label for='choice_21_27_3' id='label_21_27_3' class='gform-field-label gform-field-label--type-inline'>Guardian<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_391\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_4col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Child&#039;s Race (Check all that apply)<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_391'><li class='gchoice gchoice_21_391_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_391.1' type='checkbox'  value='American-Indian'  id='choice_21_391_1' tabindex='32'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_391_1' id='label_21_391_1' class='gform-field-label gform-field-label--type-inline'>American-Indian or Alaskan Native<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_391_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_391.2' type='checkbox'  value='Asian'  id='choice_21_391_2' tabindex='33'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_391_2' id='label_21_391_2' class='gform-field-label gform-field-label--type-inline'>Asian<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_391_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_391.3' type='checkbox'  value='Black or African-American'  id='choice_21_391_3' tabindex='34'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_391_3' id='label_21_391_3' class='gform-field-label gform-field-label--type-inline'>Black or African-American<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_391_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_391.4' type='checkbox'  value='Native Hawaiian'  id='choice_21_391_4' tabindex='35'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_391_4' id='label_21_391_4' class='gform-field-label gform-field-label--type-inline'>Native Hawaiian \/ Other Pacific Islander<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_391_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_391.5' type='checkbox'  value='White'  id='choice_21_391_5' tabindex='36'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_391_5' id='label_21_391_5' class='gform-field-label gform-field-label--type-inline'>White<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_391_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_391.6' type='checkbox'  value='Multi or Bi-racial'  id='choice_21_391_6' tabindex='37'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_391_6' id='label_21_391_6' class='gform-field-label gform-field-label--type-inline'>Multi or Bi-racial<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_391_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_391.7' type='checkbox'  value='Other'  id='choice_21_391_7' tabindex='38'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_391_7' id='label_21_391_7' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_391_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_391.8' type='checkbox'  value='Unspecified'  id='choice_21_391_8' tabindex='39'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_391_8' id='label_21_391_8' class='gform-field-label gform-field-label--type-inline'>Unspecified<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_392\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Hispanic<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_392'>\n\t\t\t<li class='gchoice gchoice_21_392_0'>\n\t\t\t\t<input name='input_392' type='radio' value='Yes'  id='choice_21_392_0' tabindex='40'   \/>\n\t\t\t\t<label for='choice_21_392_0' id='label_21_392_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_392_1'>\n\t\t\t\t<input name='input_392' type='radio' value='No'  id='choice_21_392_1' tabindex='41'   \/>\n\t\t\t\t<label for='choice_21_392_1' id='label_21_392_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_393\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_393'>Primary Language<\/label><div class='ginput_container ginput_container_text'><input name='input_393' id='input_21_393' type='text' value='' class='medium'   tabindex='42'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_394\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Primary Language Proficiency<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_394'>\n\t\t\t<li class='gchoice gchoice_21_394_0'>\n\t\t\t\t<input name='input_394' type='radio' value='Little'  id='choice_21_394_0' tabindex='43'   \/>\n\t\t\t\t<label for='choice_21_394_0' id='label_21_394_0' class='gform-field-label gform-field-label--type-inline'>Little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_394_1'>\n\t\t\t\t<input name='input_394' type='radio' value='Moderate'  id='choice_21_394_1' tabindex='44'   \/>\n\t\t\t\t<label for='choice_21_394_1' id='label_21_394_1' class='gform-field-label gform-field-label--type-inline'>Moderate<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_394_2'>\n\t\t\t\t<input name='input_394' type='radio' value='Proficient'  id='choice_21_394_2' tabindex='45'   \/>\n\t\t\t\t<label for='choice_21_394_2' id='label_21_394_2' class='gform-field-label gform-field-label--type-inline'>Proficient<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_395\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_395'>Secondary Language<\/label><div class='ginput_container ginput_container_text'><input name='input_395' id='input_21_395' type='text' value='' class='medium'   tabindex='46'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_396\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Secondary Language Proficiency<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_396'>\n\t\t\t<li class='gchoice gchoice_21_396_0'>\n\t\t\t\t<input name='input_396' type='radio' value='Little'  id='choice_21_396_0' tabindex='47'   \/>\n\t\t\t\t<label for='choice_21_396_0' id='label_21_396_0' class='gform-field-label gform-field-label--type-inline'>Little<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_396_1'>\n\t\t\t\t<input name='input_396' type='radio' value='Moderate'  id='choice_21_396_1' tabindex='48'   \/>\n\t\t\t\t<label for='choice_21_396_1' id='label_21_396_1' class='gform-field-label gform-field-label--type-inline'>Moderate<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_396_2'>\n\t\t\t\t<input name='input_396' type='radio' value='Proficient'  id='choice_21_396_2' tabindex='49'   \/>\n\t\t\t\t<label for='choice_21_396_2' id='label_21_396_2' class='gform-field-label gform-field-label--type-inline'>Proficient<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_398\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_inline field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Enrolled Days<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_398'><li class='gchoice gchoice_21_398_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_398.1' type='checkbox'  value='Monday'  id='choice_21_398_1' tabindex='50'  aria-describedby=\"gfield_description_21_398\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_21_398_1' id='label_21_398_1' class='gform-field-label gform-field-label--type-inline'>Monday<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_398_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_398.2' type='checkbox'  value='Tuesday'  id='choice_21_398_2' tabindex='51'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_398_2' id='label_21_398_2' class='gform-field-label gform-field-label--type-inline'>Tuesday<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_398_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_398.3' type='checkbox'  value='Wednesday'  id='choice_21_398_3' tabindex='52'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_398_3' id='label_21_398_3' class='gform-field-label gform-field-label--type-inline'>Wednesday<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_398_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_398.4' type='checkbox'  value='Thursday'  id='choice_21_398_4' tabindex='53'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_398_4' id='label_21_398_4' class='gform-field-label gform-field-label--type-inline'>Thursday<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_398_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_398.5' type='checkbox'  value='Friday'  id='choice_21_398_5' tabindex='54'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_398_5' id='label_21_398_5' class='gform-field-label gform-field-label--type-inline'>Friday<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_21_398'>Only Applicable to Centers Offering Part-Time Seats<\/div><\/li><li id=\"field_21_16\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Parent\/Guardian Information<\/h2><\/li><li id=\"field_21_17\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Mother\/Guardian Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_17'>\n                            \n                            <span id='input_21_17_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.3' id='input_21_17_3' value='' tabindex='56'  aria-required='true'     \/>\n                                                    <label for='input_21_17_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_17_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.6' id='input_21_17_6' value='' tabindex='58'  aria-required='true'     \/>\n                                                    <label for='input_21_17_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_21_4\" class=\"gfield gfield--type-email gfield--input-type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_4'>Mother\/Guardian Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_21_4' type='email' value='' class='medium' tabindex='60'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_21_3\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_3'>Mother\/Guardian Cell Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_21_3' type='tel' value='' class='medium' tabindex='61'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_447\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_447'>I hereby permit Young Minds in Motion to text message my cell phone number only when important announcements must be communicated, such as emergencies, school closing, and other events that will affect my child&#039;s care. (Please Initial)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_447' id='input_21_447' type='text' value='' class='small'   tabindex='62'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_399\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_399'>Mother\/Guardian Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_399' id='input_21_399' type='tel' value='' class='medium' tabindex='63'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_400\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_400'>Mother\/Guardian Work Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_400' id='input_21_400' type='tel' value='' class='medium' tabindex='64'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_401\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_401'>Mother\/Guardian Place of Employment<\/label><div class='ginput_container ginput_container_text'><input name='input_401' id='input_21_401' type='text' value='' class='medium'   tabindex='65'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_462\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_462'>Mother&#039;s Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_462' id='input_21_462' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon' tabindex='66'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_21_462_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_21_462_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_21_462' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_21_405\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Parent\/Guardian Marital Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_405'>\n\t\t\t<li class='gchoice gchoice_21_405_0'>\n\t\t\t\t<input name='input_405' type='radio' value='Single'  id='choice_21_405_0' tabindex='67'   \/>\n\t\t\t\t<label for='choice_21_405_0' id='label_21_405_0' class='gform-field-label gform-field-label--type-inline'>Single<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_405_1'>\n\t\t\t\t<input name='input_405' type='radio' value='Married'  id='choice_21_405_1' tabindex='68'   \/>\n\t\t\t\t<label for='choice_21_405_1' id='label_21_405_1' class='gform-field-label gform-field-label--type-inline'>Married<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_405_2'>\n\t\t\t\t<input name='input_405' type='radio' value='Separated'  id='choice_21_405_2' tabindex='69'   \/>\n\t\t\t\t<label for='choice_21_405_2' id='label_21_405_2' class='gform-field-label gform-field-label--type-inline'>Separated<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_405_3'>\n\t\t\t\t<input name='input_405' type='radio' value='Divorced'  id='choice_21_405_3' tabindex='70'   \/>\n\t\t\t\t<label for='choice_21_405_3' id='label_21_405_3' class='gform-field-label gform-field-label--type-inline'>Divorced<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_405_4'>\n\t\t\t\t<input name='input_405' type='radio' value='Widowed'  id='choice_21_405_4' tabindex='71'   \/>\n\t\t\t\t<label for='choice_21_405_4' id='label_21_405_4' class='gform-field-label gform-field-label--type-inline'>Widowed<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_21\" class=\"gfield gfield--type-name gfield--input-type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Father&#039;s Name<\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_21_21'>\n                            \n                            <span id='input_21_21_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_21.3' id='input_21_21_3' value='' tabindex='73'  aria-required='false'     \/>\n                                                    <label for='input_21_21_3' class='gform-field-label gform-field-label--type-sub '>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_21_21_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_21.6' id='input_21_21_6' value='' tabindex='75'  aria-required='false'     \/>\n                                                    <label for='input_21_21_6' class='gform-field-label gform-field-label--type-sub '>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_21_22\" class=\"gfield gfield--type-email gfield--input-type-email gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_22'>Father&#039;s Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_22' id='input_21_22' type='email' value='' class='medium' tabindex='77'    aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_21_23\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_23'>Father&#039;s Cell Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_23' id='input_21_23' type='tel' value='' class='medium' tabindex='78'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_448\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_448'>I hereby permit Young Minds in Motion to text message my cell phone number only when important announcements must be communicated, such as emergencies, school closing, and other events that will affect my child&#039;s care. (Please Initial)<\/label><div class='ginput_container ginput_container_text'><input name='input_448' id='input_21_448' type='text' value='' class='small'   tabindex='79'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_402\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_402'>Father&#039;s Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_402' id='input_21_402' type='tel' value='' class='medium' tabindex='80'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_403\" class=\"gfield gfield--type-phone gfield--input-type-phone gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_403'>Father&#039;s Work Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_403' id='input_21_403' type='tel' value='' class='medium' tabindex='81'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_404\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_404'>Father&#039;s Place of Employment<\/label><div class='ginput_container ginput_container_text'><input name='input_404' id='input_21_404' type='text' value='' class='medium'   tabindex='82'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_463\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_463'>Father&#039;s Date of Birth<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_463' id='input_21_463' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon' tabindex='83'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_21_463_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_21_463_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_21_463' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_21_406\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Parent\/Guardian Marital Status<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_406'>\n\t\t\t<li class='gchoice gchoice_21_406_0'>\n\t\t\t\t<input name='input_406' type='radio' value='Single'  id='choice_21_406_0' tabindex='84'   \/>\n\t\t\t\t<label for='choice_21_406_0' id='label_21_406_0' class='gform-field-label gform-field-label--type-inline'>Single<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_406_1'>\n\t\t\t\t<input name='input_406' type='radio' value='Married'  id='choice_21_406_1' tabindex='85'   \/>\n\t\t\t\t<label for='choice_21_406_1' id='label_21_406_1' class='gform-field-label gform-field-label--type-inline'>Married<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_406_2'>\n\t\t\t\t<input name='input_406' type='radio' value='Separated'  id='choice_21_406_2' tabindex='86'   \/>\n\t\t\t\t<label for='choice_21_406_2' id='label_21_406_2' class='gform-field-label gform-field-label--type-inline'>Separated<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_406_3'>\n\t\t\t\t<input name='input_406' type='radio' value='Divorced'  id='choice_21_406_3' tabindex='87'   \/>\n\t\t\t\t<label for='choice_21_406_3' id='label_21_406_3' class='gform-field-label gform-field-label--type-inline'>Divorced<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_406_4'>\n\t\t\t\t<input name='input_406' type='radio' value='Widowed'  id='choice_21_406_4' tabindex='88'   \/>\n\t\t\t\t<label for='choice_21_406_4' id='label_21_406_4' class='gform-field-label gform-field-label--type-inline'>Widowed<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_83\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_83'>Comments<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_83' id='input_21_83' class='textarea medium' tabindex='89'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_21_84\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Payment Option<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_21_84'>\n\t\t\t<li class='gchoice gchoice_21_84_0'>\n\t\t\t\t<input name='input_84' type='radio' value='Private Pay'  id='choice_21_84_0' tabindex='90'   \/>\n\t\t\t\t<label for='choice_21_84_0' id='label_21_84_0' class='gform-field-label gform-field-label--type-inline'>Private Pay<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_84_1'>\n\t\t\t\t<input name='input_84' type='radio' value='ACS Voucher'  id='choice_21_84_1' tabindex='91'   \/>\n\t\t\t\t<label for='choice_21_84_1' id='label_21_84_1' class='gform-field-label gform-field-label--type-inline'>ACS Voucher<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_84_2'>\n\t\t\t\t<input name='input_84' type='radio' value='HRA Voucher'  id='choice_21_84_2' tabindex='92'   \/>\n\t\t\t\t<label for='choice_21_84_2' id='label_21_84_2' class='gform-field-label gform-field-label--type-inline'>HRA Voucher<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_21_84_3'>\n\t\t\t\t<input name='input_84' type='radio' value='DOE'  id='choice_21_84_3' tabindex='93'   \/>\n\t\t\t\t<label for='choice_21_84_3' id='label_21_84_3' class='gform-field-label gform-field-label--type-inline'>DOE<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_349\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2016\/09\/YMIM-logo-web-e1479431836470.png\"\/ style=\"width:250px; height:100px;\"><\/li><li id=\"field_21_110\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"text-align:center; text-decoration:underline; \">Young Minds in Motion Disciplinary Procedures & Policies<\/h2>\n<p style=\"text-align: center;\">A very important part of the preschool experience is helping children learn how to get along in the world, enjoy being with other children, and follow the direction of an adult other than their parent. A caring and positive approach will be taken regarding behavior management and discipline. The teachers will focus on the positive behaviors of the children and reinforce those behaviors as often as possible. Our goal is to help the children develop self-control and responsibility for their actions. <\/p>\n<\/li><li id=\"field_21_344\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"text-align:left;\">1. Encouraging children to use their words when having a disagreement with another child facilitating children in their attempts to settle their own disputes.<br\/>\n2. Redirecting behavior when this seems potentially effective.<br\/>\n3. Separating a child from the group (Time-Out) \u2013 one minute away for each year of age.<br\/>\n4. Counseling children individually about their behaviors.<\/br>\n5. Making parents aware of disciplinary concerns (Incident Report). <\/p>\n<strong>Disruptive Behavior distracts from the full benefit of the preschool program and will result in consequences. The following behaviors are considered disruptive: <\/strong>\n<p>\n\u2022 Requires constant attention from the staff<br\/>\n\u2022 Inflicts physical or emotional harm on other children, adults, or self<\/br>\n\u2022 Disrespects people and materials provided in the program<\/br>\n\u2022 Consistently disobeys the rules of the classroom<\/br>\n\u2022 Verbally threatens other students and\/or staff<\/br>\n\u2022 Uses verbal or physical activity that diverts attention away from the group of children. <\/br>\n<\/p>\n<\/li><li id=\"field_21_111\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"text-align:center; text-decoration:underline;\">Discipline Procedures for disruptive behavior<\/h2>\n<p><span style=\"strong\">Level 1:<\/strong> Student and teacher discussion, and teacher\u2019s procedure of notification to parent through Kinderlime and phone contact. Teacher discusses behavior with the student and student receives an infraction(s) based on their choice(s). Time outs and sitting out an activity.<\/p>\n<p><span style=\"strong\">Level 2:<\/strong> Student and teacher discussion, student may possibly receive time to think about their choices, as well as teacher\u2019s procedure of notification to parent through the class behavioral\nmanagement program. <\/p>\n<p><span style=\"strong\">Level 3:<\/strong>  Once a child has served 3 time outs, or 3 parent notifications for behavior, a parent\/teacher conference will be arranged to discuss positive solutions. <\/p>\n<p><span style=\"strong\">Level 4:<\/strong> Parent meeting with administration. <\/p>\n<p><span style=\"strong\">Level 5:<\/strong> Suspension \u2013Depending on the infraction (one day up to 5 days). <\/p>\n<p><span style=\"strong\">Level 6:<\/strong> Dismissal -When little or no change is evident, and school personnel have exhausted all available means to affect change, and\/or the welfare of the other students is endangered, the student will be expelled. This decision rests with the school administration. <\/p>\n<p>Children cannot become self-disciplined unless adults teach them right from wrong. At Young Minds in Motion, children will be taught the expectations for correct behavior and encouraged to live and act accordingly. When children know something is wrong, and choose to do it\nanyway, consequences will follow to communicate that the behavior is not acceptable and will not be tolerated in our school. <\/p>\n<\/li><li id=\"field_21_114\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Discipline Policy Agreement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_114.1' id='input_21_114_1' type='checkbox' value='1' tabindex='94'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_114_1' >I have read Young Minds in Motion Disciplinary Policies and Procedures. I have discussed this with my child and agree to comply with the discipline policies and procedures of Young Minds in Motion<\/label><input type='hidden' name='input_114.2' value='I have read Young Minds in Motion Disciplinary Policies and Procedures. I have discussed this with my child and agree to comply with the discipline policies and procedures of Young Minds in Motion' class='gform_hidden' \/><input type='hidden' name='input_114.3' value='6' class='gform_hidden' \/><\/div><\/li><li id=\"field_21_112\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><hr style=\"margin-top:50px; margin-bottom:50px;\">\n<\/li><li id=\"field_21_115\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 style=\"text-align:center; text-transform:uppercase;\">Biting Policy<\/h2>\n<p style=\"text-align:center;\"><em>Although it is not uncommon for very young children to bite, it is a behavior that is taken very seriously, and is strongly discouraged.\nWhen children are older than 24 months, biting is less common. Language is beginning to become the tool of choice, with \u201cNo!\u201d and \u201cMine!\u201d is used most\nfrequently. These verbal warnings alert the teachers that it may be time to intervene, and redirect the playmates involved in another direction. When an older\nchild bites, the preschool\u2019s policy is:<\/em><\/p><\/li><li id=\"field_21_116\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><ul>\n<li><strong>1st offense<\/strong> the child who bites will quickly be placed in \u201cTime Out\u201d, while the teacher comforts the child who has been bitten, and attends to\ncleaning the bite. Then, the teacher will return to \u201cTime Out\u201d and speak with the offending child about what has happened. The child is reminded that teeth are for eating food & smiling, not for biting. Both sets of parents will\nbe told of the incident. The parent of the child that bit the other student will be asked to come and pick up the child for early dismissal.<\/li>\n<li><strong>2nd offense<\/strong>The child\u2019s parents will be asked to keep their child at home for 2 days and focus on helping the child understand that biting is unacceptable<\/li>\n<li><strong>3rd offense <\/strong>removal from the program for the remainder of the school year.<\/li>\n<\/ul><\/li><li id=\"field_21_117\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_117.1' id='input_21_117_1' type='checkbox' value='1' tabindex='95'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_117_1' >I have read Young Minds Biting Policies. I have discussed this with my child and agree to comply with the biting policies and procedures of Young Minds in Motion<\/label><input type='hidden' name='input_117.2' value='I have read Young Minds Biting Policies. I have discussed this with my child and agree to comply with the biting policies and procedures of Young Minds in Motion' class='gform_hidden' \/><input type='hidden' name='input_117.3' value='6' class='gform_hidden' \/><\/div><\/li><li id=\"field_21_118\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2016\/09\/YMIM-logo-2.png\" width=\"247\" height=\"90\" \/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\">\n<h2 style=\"text-align:center; text-transform:uppercase;\">Transportation Agreement<\/h2>\n\nI give permission for Young Minds in Motion, or any approved employee of Young Minds in Motion, to transport my child via company vehicle for the following reasons (select all that apply):<\/li><li id=\"field_21_505\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_505'>Field Trips<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_505' id='input_21_505' class='medium gfield_select' tabindex='96'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_21_507\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_507'>Morning Pick-up Service<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_507' id='input_21_507' class='medium gfield_select' tabindex='97'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_21_508\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_508'>Evening Drop-off Service<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_508' id='input_21_508' class='medium gfield_select' tabindex='98'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_21_509\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_509'>Excursions to the park<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_509' id='input_21_509' class='medium gfield_select' tabindex='99'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_21_510\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_510'>Emergency Purposes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_510' id='input_21_510' class='medium gfield_select' tabindex='100'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_21_511\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_511'>Any<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_511' id='input_21_511' class='medium gfield_select' tabindex='101'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_21_456\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><ol>\n<li>The caregiver will never leave my child(ren) unattended in any motor vehicle or other form of transportation.<\/li>\n<li>Each child will board or leave a vehicle from the curbside of the street.<\/li>\n<li>My child(ren) will be secured in safety seats or by safety belts as appropriate for the age of the child(ren) in accordance with the law.<\/li>\n<li>Any motor vehicle used to transport my child(ren) will have current registration and inspection stickers, and must be operated by a person who is at least 18 years of age and possesses a valid driver\u2019s license.<\/li>\n<li>The caregiver will notify me in advance of any instance where my child(ren) will be transported while in care.<\/li>\n<\/ol><\/li><li id=\"field_21_452\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>This form is to authorize my child\u2019s participation in all field trips organized and conducted by Young Minds in Motion.<\/p>\n<p>This form is also a statement of release of liability as detailed below. <\/p>\n<p>Note: Information will be sent home prior to each field trip detailing where the field trip will take place. You, the parent\/guardian, will be allowed to disallow your child\u2019s participation in any outing should you choose to do so. <\/p>\n<p>The undersigned Parent\/Guardian (hereinafter, \u201cI\u201d) understands that the students will be chaperoned\/supervised while en route, participating and during schedule time, and that normal precautions will be taken in their interest for safety and well-being. <\/p>\n<p>I hereby agree to release Young Minds in Motion and its trustees, employees, volunteers and sponsors (collectively, the \u201cIndemnities\u201d) and to indemnify and hold the indemnities harmless form all actions, claims, liability, and expenses, whether known or unknown, present or future \n(and expressly including (1) actions brought or claims made by the student named above after reaching the age of majority, and (2) actions or claims for damages caused in whole or in part by the negligence or gross negligence of the indemnities) relating to or arising from or connected in any manner with the student\u2019s participation in the field trip identified herein. <\/p>\n<p>In case of emergency, I give my approval and authorization for first-aid treatment and any medical treatment by local physicians and\/or hospital including surgical procedures.  I agree to accept responsibility for payment of all charges incurred during this medical treatment. <\/p>\n<p>This form must be signed and returned to the owner, director or administrator in charge of this group on the day of departure. No student will be permitted to go on the field trip that has not completed this form and returned it to the proper school personnel.<\/p><\/li><li id=\"field_21_457\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>I hereby give consent to my child the use of all the equipment of the Playground on-site and\/or off-site of Young Minds in Motion. Equipment of the playground includes swing sets, all climbing structure, slides, bikes, scooters. I recognize that injuries may occur. I fully understand that the members of Young Minds in Motion are not physicians or medical practitioners of any kind. With the above in mind, I hereby allow Young Minds in Motion staff members to give first aid to my child or children in the event of any injury or illness, and if deemed necessary by the Daycare to call 911 to seek medical help, including transportation to any healthcare facility or hospital.<\/p>\n<p>I understand that it is the express intent of Young Minds in Motion to provide for the safety and protection of my child and, in consideration for allowing my child to play at the playground, I hereby release Young Minds in Motion and its employees from all liability for any and all damages and injuries suffered by my child while playing at the playground. I also affirm that I now have and will continue to provide proper hospitalization, health and accident insurance coverage, which I consider adequate for my child protection and my own protection. I also understand that my child will be with supervision at all times they are playing at the park. This acknowledgment of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent. <\/p><\/li><li id=\"field_21_450\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2016\/09\/YMIM-logo-2.png\" width=\"247\" height=\"90\" \/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\">\n<h2 style=\"text-align:center; text-transform:uppercase;\">Tuition Agreement Form<\/h2><\/li><li id=\"field_21_458\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Tuition Agreement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_458'><li class='gchoice gchoice_21_458_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_458.1' type='checkbox'  value='Private'  id='choice_21_458_1' tabindex='102'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_458_1' id='label_21_458_1' class='gform-field-label gform-field-label--type-inline'>Private: I understand that my child\u2019s tuition is an ongoing monthly fee and I am responsible for my child\u2019s tuition amount based on his\/her scheduled days, regardless of any days my child is ill, on vacation, or does not attend for any other reason. Deposits will be accepted on a case-by-case basis. Deposits are non-refundable.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_458_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_458.2' type='checkbox'  value='ACS'  id='choice_21_458_2' tabindex='103'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_458_2' id='label_21_458_2' class='gform-field-label gform-field-label--type-inline'>ACS: I understand that my child\u2019s co-pay is an ongoing weekly fee and I am responsible for my child\u2019s co-payment based on the ACS form. I am responsible for my child\u2019s weekly co-pay fee even if my child does NOT attend for the week or is absent for 1 or more days during the week.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_458_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_458.3' type='checkbox'  value='HRA'  id='choice_21_458_3' tabindex='104'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_458_3' id='label_21_458_3' class='gform-field-label gform-field-label--type-inline'>HRA: I understand that my child\u2019s co-pay is an ongoing weekly fee and I am responsible for my child\u2019s co-payment based on the HRA form. If my child attends for one day out of the week I am still responsible to pay the weekly fee.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_124\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 style=\"text-transform:uppercase;\">Payment Schedules<\/h3>\n<p>You will be billed on Fridays for payments due that Sunday which is for services for the following week. If no payment is made by Monday night, and no arrangements have been made, there will be no service until payment is made. Although your child is not allowed to attend while tuition is unpaid, you are still responsible for payment for the time they are not there. A bill will be sent to you via email and must be paid ONLY via the Procare app.<\/p><\/li><li id=\"field_21_461\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Payment Schedules<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_461'><li class='gchoice gchoice_21_461_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_461.1' type='checkbox'  value='Private'  id='choice_21_461_1' tabindex='105'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_461_1' id='label_21_461_1' class='gform-field-label gform-field-label--type-inline'>Private: Late payments and Non-Payments: I understand that payments made after the tenth of the day of the month are considered late and a late fee of $35 will be assessed. I am aware that if the 10th day of the month falls on a weekend\/holiday the last day tuition can be paid without a late fee is the last day the center is open before the holiday\/weekend.<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_461_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_461.2' type='checkbox'  value='ACSHRA'  id='choice_21_461_2' tabindex='106'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_461_2' id='label_21_461_2' class='gform-field-label gform-field-label--type-inline'>ACS &amp; HRA: Late payments and Non-Payments: I understand that payments made after the Monday after the previous Friday of the week are considered late and a late fee of $5\/day will be assessed. I am aware that if the Friday\/Monday of the week falls on a weekend\/holiday, the last day that tuition can be paid without a late fee is the day prior to when the center is open before the weekend\/ holiday.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_129\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><strong>Delinquent Accounts:<\/strong> I understand that if accounts continue to be delinquent, the center has the right to discontinue services.<\/p>\n\n<p><strong>Returned Checks:<\/strong> I understand that if my tuition check is returned for any reason, I will be charged a processing fee of $25.00. I understand that if Young Minds in Motion receives two or more returned checks from my family, they will no longer accept checks as a method of payment.<\/p>\n\nYoung Minds in Motion does not discriminate based on disability in the admission\/access to our program.<\/li><li id=\"field_21_130\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_130.1' id='input_21_130_1' type='checkbox' value='1' tabindex='107'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_130_1' >I understand and agree with all the aforementioned terms listed in the Tuition Agreement.<\/label><input type='hidden' name='input_130.2' value='I understand and agree with all the aforementioned terms listed in the Tuition Agreement.' class='gform_hidden' \/><input type='hidden' name='input_130.3' value='6' class='gform_hidden' \/><\/div><\/li><li id=\"field_21_131\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2016\/09\/YMIM-logo-2.png\" width=\"247\" height=\"90\" \/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\">\n<h2 style=\"text-align:center; text-transform:uppercase;\">Daily ProceduresAgreement<\/h2>\n<p>Please initial each item below: <\/p><\/li><li id=\"field_21_133\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_133'>Attendance (please initial)<\/label><div class='ginput_container ginput_container_text'><input name='input_133' id='input_21_133' type='text' value='' class='small'  aria-describedby=\"gfield_description_21_133\" tabindex='108'   aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_21_133'>I agree to sign the school attendance log when my child arrives in the morning and again when he\/she is picked\nup at the end of the day. No one under the age of 16 is allowed to sign my child in\/out of the school. <\/div><\/li><li id=\"field_21_134\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_134'>Illness (Please Initial)<\/label><div class='ginput_container ginput_container_text'><input name='input_134' id='input_21_134' type='text' value='' class='small'  aria-describedby=\"gfield_description_21_134\" tabindex='109'   aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_21_134'>Illness: I understand that I will be notified by school personnel if my child becomes ill during the day and I agree to\nmake every effort to have my child picked up in a timely manner, as the health and safety of all children is of the utmost\nimportance. If my child is exposed to or contracts a contagious disease, I agree to notify the school and I will make certain that he\/she does not return to school without written permission from my child\u2019s doctor. <\/div><\/li><li id=\"field_21_135\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_135'>Withdrawal (Please Initial)<\/label><div class='ginput_container ginput_container_text'><input name='input_135' id='input_21_135' type='text' value='' class='small'  aria-describedby=\"gfield_description_21_135\" tabindex='110'   aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_21_135'>Withdrawal from Young Minds in Motion: I have the right to withdraw my child from the program at any time; however, I understand that I must provide a 2-week written notice of withdrawal. If this written notification is not received I\nagree to pay all the tuition for the 2-week period. I understand that if I then choose to re-enroll my child, she\/he will only be readmitted based upon space availability and at the current rate of tuition.<\/div><\/li><li id=\"field_21_136\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_136'>Director Withdrawal (Please Initial)<\/label><div class='ginput_container ginput_container_text'><input name='input_136' id='input_21_136' type='text' value='' class='small'  aria-describedby=\"gfield_description_21_136\" tabindex='111'   aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_21_136'>At the Director\u2019s discretion, Young Minds in Motion has the right to ask a child to withdraw from our program. A\na two-week written notice will be given for your child not to return for the following month. <\/div><\/li><li id=\"field_21_137\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_137'>Inclement Weather (Please Initial)<\/label><div class='ginput_container ginput_container_text'><input name='input_137' id='input_21_137' type='text' value='' class='small'  aria-describedby=\"gfield_description_21_137\" tabindex='112'   aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_21_137'>Inclement Weather\/School Closings: I understand that it is the Day Cares\u2019 objective to be open during every\nregularly scheduled school day; however, there are some specific days during which the school will be closed (i.e. federal holidays). In addition, inclement weather and or natural\/national disaster or major building issues may necessitate an immediate school closing. This will not affect my child\u2019s tuition in any way.<\/div><\/li><li id=\"field_21_138\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_138.1' id='input_21_138_1' type='checkbox' value='1' tabindex='113'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_138_1' >I understand and agree with all the aforementioned terms listed in the Daily Procedures.<\/label><input type='hidden' name='input_138.2' value='I understand and agree with all the aforementioned terms listed in the Daily Procedures.' class='gform_hidden' \/><input type='hidden' name='input_138.3' value='6' class='gform_hidden' \/><\/div><\/li><li id=\"field_21_139\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2016\/09\/YMIM-logo-2.png\" width=\"247\" height=\"90\" \/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\">\n<h2 style=\"text-align:center; text-transform:uppercase;\">Emergency Release and Authorized Escorts List <\/h2>\n<p>To maintain the safety of your children, Parents\/Guardians must complete, sign, and return this form to Young Minds in Motion upon enrollment. This form shall be updated periodically or when there are changes in the Emergency Release and Authorized Escort information.<\/p>\n<\/li><li id=\"field_21_140\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Emergency Release Contacts: <\/h3>\n<p>Only individuals listed below will be considered as designated emergency release persons. Government-issued ID will be required at the time of pick up. All release persons must be above 16 years of age. Please submit a photo ID of all individuals listed below. <\/p>\n<\/li><li id=\"field_21_351\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_351'>(1) Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_351' id='input_21_351' type='text' value='' class='medium'   tabindex='114'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_352\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_352'>(1) Relationship to Child:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_352' id='input_21_352' type='text' value='' class='medium'   tabindex='115'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_354\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_354'>(1) Cell Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_354' id='input_21_354' type='text' value='' class='medium'   tabindex='116'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_433\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_433'>(1) Home Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_433' id='input_21_433' type='text' value='' class='medium'   tabindex='117'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_357\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_357'>(2) Name<\/label><div class='ginput_container ginput_container_text'><input name='input_357' id='input_21_357' type='text' value='' class='medium'   tabindex='118'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_358\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_358'>(2) Relationship to Child:<\/label><div class='ginput_container ginput_container_text'><input name='input_358' id='input_21_358' type='text' value='' class='medium'   tabindex='119'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_359\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_359'>(2) Cell Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_359' id='input_21_359' type='text' value='' class='medium'   tabindex='120'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_436\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_436'>(2) Home Address<\/label><div class='ginput_container ginput_container_text'><input name='input_436' id='input_21_436' type='text' value='' class='medium'   tabindex='121'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_362\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_362'>(3) Name<\/label><div class='ginput_container ginput_container_text'><input name='input_362' id='input_21_362' type='text' value='' class='medium'   tabindex='122'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_363\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_363'>(3) Relationship to Child:<\/label><div class='ginput_container ginput_container_text'><input name='input_363' id='input_21_363' type='text' value='' class='medium'   tabindex='123'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_364\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_364'>(3) Cell Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_364' id='input_21_364' type='text' value='' class='medium'   tabindex='124'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_438\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_438'>(3) Home Address<\/label><div class='ginput_container ginput_container_text'><input name='input_438' id='input_21_438' type='text' value='' class='medium'   tabindex='125'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_367\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_367'>(4) Name<\/label><div class='ginput_container ginput_container_text'><input name='input_367' id='input_21_367' type='text' value='' class='medium'   tabindex='126'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_368\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_368'>(4) Relationship to Child:<\/label><div class='ginput_container ginput_container_text'><input name='input_368' id='input_21_368' type='text' value='' class='medium'   tabindex='127'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_369\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_369'>(4) Cell Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_369' id='input_21_369' type='text' value='' class='medium'   tabindex='128'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_441\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_441'>(4) Home Address<\/label><div class='ginput_container ginput_container_text'><input name='input_441' id='input_21_441' type='text' value='' class='medium'   tabindex='129'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_372\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_372'>(5) Name<\/label><div class='ginput_container ginput_container_text'><input name='input_372' id='input_21_372' type='text' value='' class='medium'   tabindex='130'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_373\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_373'>(5) Relationship to Child:<\/label><div class='ginput_container ginput_container_text'><input name='input_373' id='input_21_373' type='text' value='' class='medium'   tabindex='131'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_374\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_374'>(5) Cell Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_374' id='input_21_374' type='text' value='' class='medium'   tabindex='132'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_443\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_443'>(5) Home Address<\/label><div class='ginput_container ginput_container_text'><input name='input_443' id='input_21_443' type='text' value='' class='medium'   tabindex='133'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_377\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_377'>(6) Name<\/label><div class='ginput_container ginput_container_text'><input name='input_377' id='input_21_377' type='text' value='' class='medium'   tabindex='134'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_378\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_378'>(6) Relationship to Child:<\/label><div class='ginput_container ginput_container_text'><input name='input_378' id='input_21_378' type='text' value='' class='medium'   tabindex='135'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_379\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_379'>(6) Cell Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_379' id='input_21_379' type='text' value='' class='medium'   tabindex='136'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_445\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_445'>(6) Home Address<\/label><div class='ginput_container ginput_container_text'><input name='input_445' id='input_21_445' type='text' value='' class='medium'   tabindex='137'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_382\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_382.1' id='input_21_382_1' type='checkbox' value='1' tabindex='138'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_382_1' >I authorize this childcare center to release my child to the individuals I have identified above.<\/label><input type='hidden' name='input_382.2' value='I authorize this childcare center to release my child to the individuals I have identified above.' class='gform_hidden' \/><input type='hidden' name='input_382.3' value='6' class='gform_hidden' \/><\/div><\/li><li id=\"field_21_175\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Authorized Escorts List Form<\/h3>\n\n<\/li><li id=\"field_21_538\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_538'>(1) Authorized Escort Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_538' id='input_21_538' type='text' value='' class='medium'   tabindex='139'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_540\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_540'>(1) Relationship to child<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_540' id='input_21_540' type='text' value='' class='medium'   tabindex='140'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_541\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_541'>(1) Home Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_541' id='input_21_541' type='text' value='' class='medium'   tabindex='141'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_542\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_542'>(1) Preferred Contact Method<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_542' id='input_21_542' class='large gfield_select' tabindex='142'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Mobile\/Cell Telephone' >Mobile\/Cell Telephone<\/option><option value='Home Telephone' >Home Telephone<\/option><option value='Work Telephone' >Work Telephone<\/option><option value='Text (Mobile)' >Text (Mobile)<\/option><option value='E-mail' >E-mail<\/option><\/select><\/div><\/li><li id=\"field_21_543\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_543'>(1) Mobile\/Cell Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_543' id='input_21_543' type='tel' value='' class='large' tabindex='143'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_544\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_544'>(1) Home Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_544' id='input_21_544' type='tel' value='' class='large' tabindex='144'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_545\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_545'>(1) Work Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_545' id='input_21_545' type='tel' value='' class='large' tabindex='145'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_552\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_552'>(1) Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_552' id='input_21_552' type='email' value='' class='large' tabindex='146'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_21_539\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_539'>(2) Authorized Escort Name<\/label><div class='ginput_container ginput_container_text'><input name='input_539' id='input_21_539' type='text' value='' class='medium'   tabindex='147'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_547\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_547'>(2) Relationship to child<\/label><div class='ginput_container ginput_container_text'><input name='input_547' id='input_21_547' type='text' value='' class='medium'   tabindex='148'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_548\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_548'>(2) Home Address<\/label><div class='ginput_container ginput_container_text'><input name='input_548' id='input_21_548' type='text' value='' class='medium'   tabindex='149'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_546\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_546'>(2) Preferred Contact Method<\/label><div class='ginput_container ginput_container_select'><select name='input_546' id='input_21_546' class='large gfield_select' tabindex='150'    aria-invalid=\"false\" ><option value='Mobile\/Cell Telephone' >Mobile\/Cell Telephone<\/option><option value='Home Telephone' >Home Telephone<\/option><option value='Work Telephone' >Work Telephone<\/option><option value='Text (Mobile)' >Text (Mobile)<\/option><option value='E-mail' >E-mail<\/option><\/select><\/div><\/li><li id=\"field_21_549\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_549'>(2) Mobile\/Cell Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_549' id='input_21_549' type='tel' value='' class='large' tabindex='151'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_550\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_550'>(2) Home Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_550' id='input_21_550' type='tel' value='' class='large' tabindex='152'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_551\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_551'>(2) Work Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_551' id='input_21_551' type='tel' value='' class='large' tabindex='153'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_553\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_553'>(2) Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_553' id='input_21_553' type='email' value='' class='large' tabindex='154'    aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_21_559\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Health Insurance Information <\/h3>\n<\/li><li id=\"field_21_560\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_560'>Health Insurance Provider<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_560' id='input_21_560' type='text' value='' class='large'   tabindex='155'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_561\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_561'>Policy #<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_561' id='input_21_561' type='text' value='' class='large'   tabindex='156'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_562\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_562'>Policy Holder Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_562' id='input_21_562' type='text' value='' class='large'   tabindex='157'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_563\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Dental Included?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_21_563'><li class='gchoice gchoice_21_563_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_563.1' type='checkbox'  value='Yes'  id='choice_21_563_1' tabindex='158'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_563_1' id='label_21_563_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_21_563_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_563.2' type='checkbox'  value='No'  id='choice_21_563_2' tabindex='159'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_21_563_2' id='label_21_563_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_21_564\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_564'>Pediatrician<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_564' id='input_21_564' type='text' value='' class='large'   tabindex='160'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_565\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_21_565'>Pediatrician&#039;s Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_565' id='input_21_565' type='text' value='' class='large'   tabindex='161'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_21_182\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2016\/09\/YMIM-logo-2.png\" width=\"247\" height=\"90\" \/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\">\n<h2 style=\"text-align:center;\">Child Illness Policy <\/h2>\n<p>On the average, babies experience eight to ten illnesses a year; preschoolers experience almost as many.\nWe know that managing the demands of work can be challenging when your child is ill. We strive to limit the spread of communicable diseases in our centers and are committed to implementing policies that balance and respect the needs of children, families, and staff in these circumstances. Our Child Illness Policy is based on the Model Health Care Policies developed by the American Academy of Pediatrics. Young Minds in Motion understands that it is difficult for a parent\/guardian to leave or miss work; therefore, it is suggested that alternative arrangements be made for occasions when children must\nremain at home or be picked up due to illness. Exclusion from the center is sometimes necessary either to reduce the transmission of illness or because the center is not able to adequately meet the needs of the child. Mild illnesses are common among children, and infections are often spread before the onset of any symptoms. In these cases, we try to keep the children comfortable throughout the day. Reasons Young Minds in Motion may exclude children include (but are not limited to) the following:<\/p>\n<\/li><li id=\"field_21_183\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >\u2022 Illness that prevents the child from participating comfortably in program activities, such as going\noutdoors.<br\/>\n\u2022 Illness that results in a greater need for care than our staff can provide without compromising the health and safety of other children.<br\/>\n\u2022 Illness that poses a risk of spread of harmful disease to others<br\/>\n\u2022 Severely ill appearance<br\/>\n\u2022 Fever of I 00 degrees or above (axillary); IO I or above (orally) or an equivalent measure accompanied by behavior change or other signs and symptoms.<br\/>\n\u2022 Fever of I 00 degrees or above (axillary) or IO I or above (orally) in an infant younger than two months; such circumstances should be medically evaluated within an hour<br\/>\n\u2022 Fever of I 04\u00b0 F or greater in a child of any age (requires immediate medical attention)<br\/>\n\u2022 Diarrhea; watery stools or decreased form of stool not associated with the change of diet; stool not contained in the diaper; child unable to reach the toilet; or stool frequency that exceeds 2 or more stools above normal for that child.<br\/>\n\u2022 Cases of bloody diarrhea and diarrhea caused by Shigella, salmonella, Shiga toxin-producing E coli,\nCryptosporidium or G intestinalis must be cleared for readmission by a health care professional.<br\/>\n\u2022 Blood or mucus in the stools not explained by dietary change, medication, or hard stools.<br\/>\n\u2022 Vomiting more than 2 times in the previous 24 hours (unless the vomiting is determined to be caused by a\nnon-communicable condition and the child is not in danger of dehydration).<br\/>\n\u2022 Mouth sores with drooling (unless the child's medical provider or local health department authority states that the child is noninfectious).<br\/>\n\u2022 Abdominal pain that continues for more than 2 hours; intermittent abdominal pain associated with fever, dehydration, or other signs of illness.<br\/>\n\u2022 Rash with fever or behavioral changes (unless a physician has determined it is not a communicable disease).<br\/>\n\u2022 Skin sores weeping fluid and on an exposed area that cannot be covered.<br\/>\n\u2022 Purulent conjunctivitis (defined as pink or red conjunctiva with white or yellow eye discharge) until on antibiotics\nfor 24 hours.<br\/>\n\u2022 Impetigo until 24 hours after treatment has been started.<br\/>\n\u2022 Strep throat (or other streptococcal infection) until 24 hours after treatment has been started.<br\/>\n\u2022 Head lice or nits until after the first treatment.<br\/>\n\u2022 Rubella, until 7 days after the rash appears.<br\/>\n\u2022 Scabies until 24 hours after treatment has been started.<br\/>\n\u2022 Chickenpox, until all lesions have dried or crusted (usually 6 days after onset of rash).<br\/>\n\u2022 Pertussis (whooping cough) until 5 days of antibiotics.<br\/>\n\u2022 Mumps, until 5 days after onset of parotid gland swelling.<br\/>\n\u2022 Measles, until 4 days after onset of rash.<br\/>\n\u2022 Hepatitis A virus until I week after onset of illness or jaundice or as directed by the health department (if the\nchild's symptoms are mild).<br\/>\n\u2022 Tuberculosis, until the child's medical provider or local health department, states the child is on appropriate\ntreatment and can return.<br\/>\n\u2022 Any child determined by the local health department to be contributing to the transmission of illness during an\noutbreak.<br\/><\/li><li id=\"field_21_184\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>For your child's comfort, and to reduce the risk of contagion, we ask that children be picked up within 1.5 hours of notification. Until then, your child will be kept comfortable and will continue to be observed for symptoms. Children need to remain home for 24 hours without symptoms before returning to the program unless the center receives a note from the child's medical provider stating that the child is not contagious and may return to the center. A note from the child's medical provider is required before any child can return to school if they have been absent for two consecutive days or more regardless of the illness. Children who have been absent may return when:<\/p>\n<\/li><li id=\"field_21_185\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >\u2022 They are free of fever, vomiting, and diarrhea for a full 24 hours.<br\/>\n\u2022 They have been treated with an antibiotic for a full 24 hours.<br\/>\n\u2022 They are able to participate comfortably in all usual program activities, including outdoor time.<br\/>\n\u2022 They are free of open, oozing skin conditions and\/or excessive mucus unless<br\/>\n\u2022 the child's medical provider signs a note stating that the child's condition is not contagious, and<br\/>\n\u2022 the involved areas can be covered by a bandage without seepage or drainage through the bandage.<br\/>\n\u2022 For those children previously suffering from diarrhea or excessively lose bowel movements, readmission can\noccur when toilet-trained children no longer have toileting accidents and diapered children cease from having\ndiarrhea.<br\/><\/li><li id=\"field_21_186\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >If a child is excluded because of a reportable communicable disease, a note from the child's medical provider stating that the child is no longer contagious is mandatory. Ultimately, the final decision on whether to exclude a child from the program due to illness will be made by the Director at Young Minds in Motion based on the safety or concern for all of the other children.\nNote: Please be aware that Notes allowing for a child's return to the center after exclusion due to illness must\noriginate from the child's medical provider.\nA note was written and signed by the child's parent\/guardian who is also a physician is not acceptable.<\/li><li id=\"field_21_187\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_187.1' id='input_21_187_1' type='checkbox' value='1' tabindex='162'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_187_1' >I agree with the above terms.<\/label><input type='hidden' name='input_187.2' value='I agree with the above terms.' class='gform_hidden' \/><input type='hidden' name='input_187.3' value='6' class='gform_hidden' \/><\/div><\/li><li id=\"field_21_188\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2016\/09\/YMIM-logo-2.png\" width=\"247\" height=\"90\" \/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\">\n<h2 style=\"text-align:center;\">Photo Consent Form <\/h2>\n<p>Photos are taken daily in our classrooms to capture the milestones that your child achieves. Photos are used for weekly newsletters, our website, quarterly parents and family newsletters, and printed marketing materials.<\/p>\n<\/li><li id=\"field_21_558\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_558.1' id='input_21_558_1' type='checkbox' value='1' tabindex='163'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_558_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_558.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_558.3' value='6' class='gform_hidden' \/><\/div><\/li><li id=\"field_21_199\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2016\/09\/YMIM-logo-2.png\" width=\"247\" height=\"90\" \/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\">\n<h2 style=\"text-align:center;\">NEW STUDENT SUPPLY LIST <\/h2>\n<p>Upon entry, the following items are required.Please make certain that all items are clearly labeled with\nyour child\u2019s name, so we can assure that it will be used for your child only. List is subject to change. <\/p>\n<\/li><li id=\"field_21_300\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >\u2022Potty Training Pull-Ups with Velcro on the Sides)<br\/>\n\u2022 Baby Wipes<br\/>\n\u2022 Seasonal Change of Clothing (pants, shirt, socks, underwear, etc.)<br\/>\n\u2022 Two (2) Crib Size Sheets and Two (2) Blankets for Nap-time (23\" x 51\")<br\/>\n\u2022 (1) Pair of Crocs \/Garden Shoes<br\/>\n\u2022 One supply box with supplies. The student's teacher will provide a list.<\/li><li id=\"field_21_197\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input name='input_197.1' id='input_21_197_1' type='checkbox' value='1' tabindex='164'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_21_197_1' >I agree with the above terms.<\/label><input type='hidden' name='input_197.2' value='I agree with the above terms.' class='gform_hidden' \/><input type='hidden' name='input_197.3' value='6' 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