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PROCEDURES FOR MEDICAL EMERGENCIES

In case of a severe injury or illness, the director, assistant director or classroom teacher will first call the Fulton County Emergency Medical Squad (911) and then call the parents. If the parents or an emergency contact are unavailable, the director or assistant director will follow the emergency vehicle to Scottish Rite Hospital (1001 Johnson Ferry Rd.)

If the injury does not warrant a call to 911, but does require immediate medical attention (and the parent or emergency contact person cannot be reached), two staff members will transport the child to Scottish Rite Hospital.

All minor injuries will be handled in house. In the case of minor illness, the parents (guardian) or emergency contact will immediately be called. If no one can be contacted, the child will remain in the director’s office until school is over or until a parent or emergency contact is reached.

Child's Name *

Child's Birthdate *

Address *

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Home Phone

Cell Phone *

Email *

Mother's Name *

Business #

Father's Name *

Business #

Allergies (foods, medicines, etc.)

Typical Allergic Reaction/Normal Treatment

Medication taken regularly, frequency & reason for use

Chronic/reoccurring illnesses

Insurance Company

Child's Physician

Phone #

PERSONS WHO MAY BE CALLED IN AN EMERGENCY IF PARENTS CANNOT BE REACHED:

Name

Relationship to Child

Phone

Name

Relationship to Child

Phone

Name

Relationship to Child

Phone

Submit

Waiver of Liability

- Step 1 of 2

It is understood that St. James Preschool will make every effort to prevent accidents, but in the case of an accident, neither the Preschool nor St. James United Methodist Church will be held liable. It is mutually understood that in the event of an accident or illness of my child while in the care of St. James Preschool, the staff shall use their best efforts to contact the parents. In the event the parent is not immediately available, however, the staff is authorized to secure such medical care as the situation may reasonably warrant. It is agreed that where the school has acted in good faith to comply with an accident/illness of my child, any and all liability as might exist, is expressly waived by the parent.

Parent Name *

Student Name *

Date *

Parent Signature *

Clear Signature

Next

Release

As parent(s) and/or legal guardian(s) of said student, do you grant permission for the St. James Preschool and/or the St. James Preschool Board to use photographs and/or videos of your child for promotional and/or instructional use?

• Yes, I grant permission
• No, I do not grant permission

Do you give permission for your child’s name, parents’ names, address, phone number and email address to be published in the St. James Preschool Directory? *

• Yes, I grant permission
• No, I do not grant permission

Parent Signature *

Clear Signature

Submit

Carpool Agreement Form

ST. JAMES PRESCHOOL PARKING LOT AND CARPOOL SAFETY GUIDELINES

I have read the St. James Preschool Parking Lot and Carpool Safety Guidelines (dated February 2022). I also agree to comply with any St. James Preschool Board approved amendments to the guidelines. I will inform all other persons (e.g., spouses, nannies, babysitters, neighbors, grandparents, friends, relatives, etc.), who come to St. James Preschool on my behalf, of the requirements in the guidelines. Any violation(s) of these guidelines and procedures by me, or anyone on St. James United Methodist Church property on my behalf, shall result in consequences which could include fines and/or revocation of my parking lot and carpool privileges.

Parent or Legal Guardian Name *

Student Name *

Address *

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Date *

Signature *

Clear Signature

Submit

General History

Child's Name *

Birth Date *

Address *

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Home Phone *

Cell Phone *

Email *

Preferred Phone Number for Directory (Choose One): *

• Home Phone
• Cell Phone

Father's Name

Education

Occupation

Employer

Mother's Name

Education

Occupation

Employer

Brothers and sisters:Select No12345

Name

Age

Name

Age

Name

Age

Name

Age

Name

Age

Is daily child care provided by someone other than the parent? If so, please provide sitter’s name and phone number:

• No
• Yes

Name

Phone

PERSONS WHO ARE AUTHORIZED TO PICK UP CHILD OTHER THAN PARENTS:

Name

Phone

Name

Phone

Name

Phone

Name

Phone

Name

Phone

Submit

Parent COVID-19 Waiver

In consideration of my children being allowed to enroll in St. James Preschool during the COVID-19 pandemic and for other good and valuable consideration, receipt of which is hereby acknowledged, on behalf of myself, my children and all others who may claim by, under, or through myself I do hereby agree to indemnify and hold harmless and do hereby release, acquit, and forever discharge the St. James Preschool and all of its officers, employees, agents and assigns, and all other persons or connected therewith from any and all claims, actions, causes of action which I or my children now have, or which may hereafter accrue, whether for personal injury or property damage, whether known or unknown, arising out of or in any way resulting from my and/or my children’s attendance of the St. James Preschool during the COVID-19 pandemic.

Please read and check each statement below.

I understand that during this COVID-19 Public Health Emergency I will NOT be permitted to enter St. James Preschool “the facility” beyond the designated drop-off and pick-up area. I understand that this procedure is for the safety of all persons present in the facility and to limit to the extent possible everyone’s risk of exposure. I understand that it is my responsibility to inform any Emergency Contact persons of the information contained herein. *

• I understand

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I understand that IF there is an emergency requiring me to enter the facility beyond the designated drop-off and pick-up area I MUST wash my hands before entering and wear a mask. While in the facility I must practice social distancing and remain 6ft from all other people, except for my own child. *

• I understand

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I understand that to enter upon the facility my child must be free from COVID-19 symptoms. If, during the day, any of the following symptoms appear my child will be separated from the rest of the children in the Preschool. I will be contacted, and my child MUST be picked up from the facility within 30 minutes of being notified. Symptoms include: (please see below) *

• I understand

Fever of 100.4 degrees Fahrenheit or higher, dry cough, shortness of breath, chills, loss of taste or smell, sore throat, muscle aches. While we understand that many of these symptoms can also be related to non-COVID-19 related issues we must proceed with an abundance of caution during this Public Health Emergency. These symptoms typically appear 2-7 days after being infected so please take them seriously. Your child will need to be symptom free without any medications for 24 hours before returning to the facility.

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I understand that my child will be required to wash their hands using CDC recommended handwashing procedures throughout the day using warm running water and rubbing with soap for at least 20 seconds. *

• I understand

---

I understand that outside of care, in order to control my child’s exposure in the community, I will comply with any and all state, county or local stay-at-home orders. I will follow any recommendations from the CDC that limits my child’s risk for exposure including wearing a mask in all public areas and remaining 6ft from all other people. *

• I understand

---

I will immediately notify St. James Preschool administration if I become aware of any person with whom my child or I have had contact exhibits any of the symptoms listed in Number 1 above, is advised to self-isolate, quarantine, or has tested positive, or is presumed positive for COVID-19. Further, I will immediately notify St. James Preschool at 404-237-7354 or Susan Viers at sviers@stjamesatlanta.org if anyone from my place of employment is presumed positive or tests positive for COVID-19 whether or not I have had direct contact with that person *

• I understand

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I understand that while present in the facility each day my child will be in contact with children, families and other employees who are also at risk of community exposure. I understand that no list of restrictions, guidelines or practices will remove 100% of the risk of exposure to COVID-19 as the virus can be transmitted by persons who are asymptomatic and before some people show signs of infection. I understand that I play a crucial role in keeping everyone in the facility safe and reducing the risk of exposure by following the practices outlined herein. *

• I understand

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I Certify & Agree

I certify that I have read, understand, and agree to comply with the provisions listed herein. I acknowledge that failure to act in accordance with the provisions listed herein, or with any other policy or procedure outlined by St. James Preschool may result in termination of services. I acknowledge that care for my child may be terminated if it is determined that my actions, or lack of action unnecessarily exposes another employee, child, or their family member to COVID-19.

Parent's Name *

Phone *

Child's Name *

Child's DOB *

Parent Signature *

Clear Signature

Date *

Parent's Name *

Phone *

Parent Signature *

Clear Signature

Date *

Submit

Please click on the link below to download our Parent Physician Medical Form. Please fill it out and return it to our front office.

Click Here