Excited To Partner with Your Family in Your Child's Development

We would like to express our gratitude for you choosing Developing Young Minds (DYM) for your childcare service needs. We understand the importance of this decision and how critical it will be in your child’s life. It is our goal to provide your family with quality childcare services. Here at DYM we believe that “it takes a village” to raise a child. To ensure your family is served in a paramount manner, we encourage you to read through our DYM Parent Handbook. We are a structured childcare facility organized and streamlined to provide an immaculate experience for our children and families. If at any time you require an adjustment in ‘drop off’ and/or ‘pick up’ times; please consult our director in advance, to allow us the opportunity to accommodate. Proper notice is the key component in allowing us the opportunity to fulfill your requests. We look forward to getting to know your child and family and growing together the next few years, building a strong healthy relationship.
Appreciating you,

Darrin Lee Jr. - Director

Enrollment Form

    Child's Information











    Please check and read each item to show your understanding and authorization.









    Parent/Guardian/Authorized Individual Information

    Parent #1



















    Parent #2



















    Emergency Contact & Pick-Up List

    Emergency Contact 1









    Emergency Contact 2









    Medical Information:




    Child's Health Care Providers:







































    Disease & Illness History


    Additional Acknowledgements, Consents, and Information

    • Hours of Operation: ACLC 1 operates Monday through Friday 6:00am – 7:30pm. ACLC 2 operates Monday through Friday 6:00am – 7:30pm. Love My Children (ACLC 3) operates Monday through Friday 6:00am – 6:00pm. These hours are the expectations except closings for holidays outlined in parent handbook and inclement weather situations. There is no reduction in the weekly tuition for absent days or days the center is closed for holiday or inclement weather.
    • Inclement Weather: The procedure to notify families should severe weather or other conditions prevent the program from opening on time or at all will be announced on the website, WHAS, WDRD, WLKY stations. If it becomes necessary to close early, we will contact you or someone listed in the Emergency Contact and Pick-Up Release, and it will be your responsibility to arrange for your child’s early pick up.
    • Tuition/Childcare Service Fee: Tuition is billed weekly and not daily. Your rate is based on the weekly enrollment slot. Absences does not decrease tuition rate unless special circumstances permit. Tuition is due the week before the week of care occurs. ___________ Parent Initials (Initialing that you understand)
      • I would prefer to make tuition payments on a: _____ weekly _____ bi-weekly ______ monthly basis.
    • In efforts to continue serving families the following information is required to be signed by the authorized individual as a guarantor for the child care services fees and related collection/court costs. If separation occurs or payment of fees becomes more than 4 weeks behind you understand that Amazing Childcare will take out a formal complaint with division for state childcare and legally through the State of Kentucky Courts. If this is selected not only will you be responsible for past due balance, but all fees associated with collection of fees. I grant Amazing Childcare with permission to contact employer and bank to initiate compliant methods at recouping fees through your wages or account. ______
    • I understand that if I am awarded a payment plan to assist in the paying for child care services that it is my responsibility to remain compliant to the original tuition payment expectation as well as the agreed payment plan. When there is a balance left I understand that there will be court fees and costs associated with ACLC pursing collection/payment of tuition balance. I accept all collection and court costs including fees associated with the collection attempt including tuition balance. ______
    • Medical Policies, Authorizations, Consents, Emergencies
      • Prior to enrollment, I must provide the center with updated medical and immunization information for my child. This information is to be kept current and updated in accordance with state child care regulations. _______
      • I agree to provide information to the child care center about my child’s conditions, illnesses, allergies or other needs. _____
      • If my child becomes ill with a reportable contagious disease, I understand that he/she will not be able to return until I bring in a physician’s note stating that he/she is no longer contagious. _____
      • If my child becomes ill during his/her time at the child care center, the staff will contact me to pick up my child. I will arrange for pick up as soon as possible and no later than 1 hour after being contacted. If I cannot be reached, the staff will contact those listed in the Child Emergency Contact and Release. I also understand that Child Protective Services, Home of the Innocence, and the Louisville Metro Police Department will be contacted in event a child is not picked up timely.
      • In case of a medical emergency, the staff will attempt to contact me, those listed in the Child Emergency Contact and Release, and lastly my physician.
      • In case of a medical emergency, I agree that my child may receive first aid and/or CPR from center staff.
      • In case of a medical emergency, I permit the transportation of my child to a local hospital or other urgent care facility, if necessary by paramedics or other emergency personnel.
      • In case of a medical emergency, I will be responsible for the emergency medical expenses.
      • In case of an accidental ingestion of a poisonous substance, I consent to my child being treated as directed by the Poison Control Center.
      • I give my permission to this center to apply □ sunscreen and □ insect repellant to my child. Please check which product you will permit.
      • I understand that I must supply my own sunscreen and/or insect repellant with a valid expiration date, and it will be labeled with my child’s name.
      • I give my permission to this center to apply diaper rash cream.

     

    By checking below, I certify that I provided all information truthfully and I understand everything that was written in this application. I understand that if I become non-compliant with the items in this enrollment application that it is my responsibility to ensure compliance. I understand that for nonpayment my childcare services may be indefinitely suspended or terminated; I am legally responsible for costs incurred while my child was in care.

    Please leave this field empty.

    You can also Download the Enrollment Packet and deliver to our location.