Enroll Your Child in Brownsville, TX

Please complete all steps of the enrollment form below. Your progress is saved as you navigate between steps.

There are several forms that are not available online. Please CLICK HERE to download them. Fill out the forms and drop them off at the center you are applying for.

Step 1 of 15 Child & Family Information

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Child & Family Information

Administrative Information

Director's Name

File Updated On

Custody Documents on File

Yes No

Date of Withdrawal

Child Information

Center Applying For

Child's First Name

Child's Last Name

Date of Birth

Date of Admission

SNAP #

Other Contact #

Child Lives With

Both Parents Mother Father Guardian

Address

Address Line 1

Address Line 2

City

State

Zip Code

Mother's Information

First Name

Last Name

Place of Employment & Department

Driver's License

Last 4 SSN

Cell #

Work #

Father's Information

First Name

Last Name

Place of Employment & Department

Driver's License

Last 4 SSN

Phone #

Cell #

Work #

Emergency Contact

First Name

Last Name

Address

City, State, Zip Code

Phone

Relationship

Authorized Pickup Persons

Authorized Pickup Person 1

First Name

Last Name

Address

City, State, Zip Code

Phone

Relationship

Authorized Pickup Person 2

First Name

Last Name

Address

City, State, Zip Code

Phone

Relationship

Authorized Pickup Person 3

First Name

Last Name

Address

City, State, Zip Code

Phone

Relationship

Permissions

Transportation Permission

Give Permission Don't Give Permission

Transport Consent For

Emergency Care Field Trips School

Field Trips Permission

Give Permission Don't Give Permission

Water Activities Permission

Give Permission Don't Give Permission

Water Activities That Apply

Water table play Splashing/wading pools Sprinkler/slides

Does your child know how to swim?

Yes No

Policies

I acknowledge receipt of written operational policies.

Meals

None Breakfast Lunch PM Snack Supper Evening Snack

Siblings Enrolled

Sibling 1 Name

Sibling 1 Date of Birth

Sibling 2 Name

Sibling 2 Date of Birth

Sibling 3 Name

Sibling 3 Date of Birth

Sibling 4 Name

Sibling 4 Date of Birth

Sibling 5 Name

Sibling 5 Date of Birth

Parent Work Schedule

You will have one hour from the times written in and out to drop off and pick up your child.

Monday

Out

Tuesday

Out

Wednesday

Out

Thursday

Out

Friday

Out

Saturday

Out

Sunday

Out

Comments / Notes

Emergency Medical Consent

Name of Physician

Physician Phone

Physician Address

Physician City, State, Zip Code

Emergency Medical Care Facility

Facility Phone

Facility Address

Facility City, State, Zip Code

Parent or Legal Guardian Signature

Date

Special Needs / Allergy Information

Does your child have diagnosed food allergies?

Yes No

I understand that if my child has allergies, I must complete the food allergy emergency care plan with my child's picture.

School Information

School Attending

Phone

Address

City, State, Zip Code

School Age & Admission Requirements

Name of School

School Phone Number

School Address

Immunization and vision/hearing records are on file at school and current

Yes No

My child has permission to:

Ride a bus Walk to or from school/home

I have provided the most current immunization record

Yes No

Admission Requirement

Health-care professional examined child within the past year and child can participate. Signed and dated health-care professional statement is attached. Medical diagnosis and treatment conflict with religious tenets; affidavit attached. Child has been examined and parent will submit signed statement within 12 months.

Health Care Professional Signature

Date

Name and Address of Health Care Professional

Parent or Legal Guardian Signature

Date

Signed health-care professional statement attached. Religious medical affidavit attached. Immunization affidavit for reasons of conscience attached. Vision/hearing screening affidavit attached.

Vision

Pass Fail

Hearing

Pass Fail

Health Requirement Form

Name of Child

Date of Birth

Vaccine

Hepatitis B

Schedule

Birth, 1-2 months, 6-8 months

Date Child Received

Vaccine

Rotavirus

Schedule

2 months, 4 months, 6 months

Date Child Received

Vaccine

Diphtheria, Tetanus, Pertussis

Schedule

2 months, 4 months, 6 months, 15-18 months, 4-6 years

Date Child Received

Vaccine

Haemophilus Influenzae Type B

Schedule

2 months, 4 months, 6 months, 12-15 months

Date Child Received

Vaccine

Pneumococcal

Schedule

2 months, 4 months, 6 months, 12-15 months

Date Child Received

Vaccine

Inactivated Poliovirus

Schedule

2 months, 4 months, 6-18 months, 4-6 years

Date Child Received

Vaccine

Influenza

Schedule

Yearly starting at 6 months

Date Child Received

Vaccine

Measles, Mumps, Rubella

Schedule

12-15 months, 4-6 years

Date Child Received

Vaccine

Varicella

Schedule

12-15 months, 4-6 years

Date Child Received

Vaccine

Hepatitis A

Schedule

12-15 months, second dose 6-18 months after first

Date Child Received

Vaccine

TB Test

Schedule

If required

Date Child Received

TB Test Date

TB Test Result

Positive No

Physician/Public Health Signature or Stamp

Verification Date

Varicella Disease Date

Parent Signature

Parent Signature Date

Financial Agreement

Child's First Name

Child's Last Name

Registration Fee: A non-refundable registration fee of $70.00 is required upon enrollment.

Tuition Payment: Tuition is due weekly, payable each Monday. Payments can be made by cash, check, or money order.

Late Fees:

2 days past due: $10.00 late fee
4 days past due: $20.00 late fee
6 days past due: child care services may be suspended

Returned Checks: A fee of $35.00 will be charged for any returned check.

Pickup Overtime: Charges apply for late pickups beyond operating hours.

Absences/Holidays: Full tuition is due regardless of absences, holidays, or closures.

Payment Increases: KidBridge Academy reserves the right to adjust tuition rates with proper notice.

Withdrawal: A minimum of 21 calendar days written notice is required for withdrawal.

Parent Handbook: I acknowledge that I have received and agree to abide by all policies outlined in the KidBridge Academy Parent Handbook.

Date

Parent or Guardian Signature

Authorized Personnel

Authorized Personnel Date

Operational Policies / Parent Acknowledgment

Parent Name

Relationship

Child's First Name

Child's Last Name

I acknowledge that I have received a copy of the KidBridge Academy Parent Handbook and understand all operational policies contained within.

Before your child's first day, the following must be provided:

Completed medical permission forms
Current immunization records
All enrollment documents

Parent Signature Date

Media/Photography Consent and Release

Child's First Name

Child's Last Name

KidBridge Academy may occasionally take photographs or videos of children participating in activities for use in newsletters, promotional materials, social media, and the academy's website.

By signing below, I give my consent for KidBridge Academy to use photographs and/or video recordings of my child for educational, promotional, and marketing purposes. I understand that my child's full name will not be used in connection with any photographs or videos without my express written consent.

Do you give consent?

Yes No

Parent First Name

Parent Last Name

Parent Signature Date

Incident Reporting Procedure

KidBridge Academy follows a 13-step incident reporting procedure to ensure the safety and well-being of every child:

Staff member witnesses or is informed of the incident.
Immediate first aid is administered as needed.
The area is secured and other children are moved to safety.
The director or assistant director is notified immediately.
Emergency services (911) are called if the situation warrants.
An incident report form is completed by the witnessing staff member.
Parents/guardians are notified as soon as possible.
Photographs of any injuries are taken for documentation.
The incident is reviewed by the director and corrective action is determined.
Licensing authorities are notified if required by law.
Follow-up care and monitoring of the child is conducted.
Staff involved receive additional training if applicable.
All documentation is filed securely for a minimum of 5 years.

Parent or Guardian Signature

Date

Authorized Personnel

Authorized Personnel Date

Child Abuse Neglect Statement

KidBridge Academy is committed to providing a safe and nurturing environment for all children. All staff members are trained in recognizing the signs and symptoms of child abuse and neglect. As mandated reporters, all employees are required by law to report any suspected cases of abuse or neglect to the appropriate authorities.

By signing below, I acknowledge my understanding of KidBridge Academy's commitment to child abuse prevention and reporting.

Parent First Name

Parent Last Name

Relationship

Child's First Name

Child's Last Name

Parent Signature Date

Sunscreen and Insect Repellent

KidBridge Academy will apply sunscreen and/or insect repellent to your child before outdoor activities. Products must be provided by the parent/guardian and clearly labeled with the child's name. Staff will apply sunscreen at least 15 minutes before outdoor play and reapply as needed throughout the day.

Please provide the following information about the products your child should use:

Name of Sunscreen

Name of Insect Repellent

Special Instructions for Sunscreen

Special Instructions for Insect Repellent

Parent/Guardian Signature Date

Weekend Care Contract

KidBridge Academy offers weekend care services subject to the following conditions:

Advance notice of at least 48 hours is required for weekend care reservations.
Parents must provide all necessary supplies including diapers, extra clothing, and any special food items.
Weekend care hours and fees are separate from regular weekday tuition.
Cancellations must be made at least 24 hours in advance to avoid charges.

Parent First Name

Parent Last Name

Parent Signature Date

Transportation Rules

Child's Name

Date

KidBridge Academy adheres to the following transportation rules and guidelines:

All vehicles used are properly maintained, inspected, and insured.
Each child must be secured in an age-appropriate car seat or seat belt.
A staff member will always be present during transport in addition to the driver.
Head counts are taken before departure, upon arrival, and before returning.
Parents must provide a signed authorization form for any transportation.
Children will only be transported for approved activities (field trips, school, emergency).
No child will be left unattended in a vehicle at any time.

Parent Printed Name

Parent Signature

Parent Orientation

Tour of the facility Introduction to teaching staff Parent visit with the classroom teacher Overview of parent handbook Policy for arrival and late arrival Extended classroom visit opportunity Texas Rising Star Quality Certification explanation CCS enrollment support information Family support resources and community activities Child development and developmental milestones Consistent arrival time expectations Limit technology use on site statement

Parent or Guardian Signature

Authorized Personnel

Date

Parent Handbook / Contract Acknowledgment

Hours of Operation Tuition Payments & Outstanding Balances Late Pick Ups Fees Child Care Tax Forms Early Dismissal In-Service Closure Upon Arrival Nap Time Upon Dismissal Release of Children Illness and Exclusion Criteria Dispensing Medication Policy Emergency Evacuation Incident Reports Discipline and Guidance Policy Nutrition Policies Allergies Immunizations Children's Dress Code Transportation Policies Outdoor Play and Water Activities Field Trip Policies Parent Concerns Open Door Policy Parent Involvement Minimum Standards Gang-Free Zone Information Breastfeeding Diapering Child Abuse & Neglect Conducting Health Checks Safe Sleep Cell Phone Policy

Child Name

Parent Name (Print)

Parent Signature

Parent Date

Director Signature

Director Date

Emergency Contact Form

Allergies

School

Mother Email

Father Email

Family Physician

Family Hospital

Siblings

Emergency Contacts

Vehicle Emergency Contact Form

Allergies

School

Family Physician

Family Hospital

Siblings

Additional Information Caregiver Should Know About

Does Your Child Have Allergies?

Yes No

Signature (Type Full Name)

Vehicle Emergency Contacts

Review & Submit

Please review all the information you've entered before submitting. By clicking "Submit Enrollment," you confirm that all information provided is accurate and complete.

After submission, a copy of your enrollment forms will be emailed to KidBridge Academy staff for processing. You may be contacted for additional information or documentation.

Application Summary

I agree to use electronic records and signatures for this enrollment packet, and I understand that typing my full name on a signature line has the same intent as signing the form.

Enrollment Submitted!

Thank you for enrolling your child at KidBridge Academy. We will review your application and contact you soon with next steps.