Families with a child enrolling in MVPNS for the first time.
Welcome to Mountain View Parent Nursery School! We are delighted to have your family join our preschool. In preparation for the upcoming school year, there are many forms that must be completed by a parent/legal guardian. Be assured that all information submitted to MVPNS is handled and maintained in a confidential manner.
Please read the information and explanations carefully. Portions of the medical forms listed below must be completed by a physician, so please allow adequate time.We suggest you make copies for your files.Please mail all forms to:
Mountain View Parent Nursery School
Attention: Membership
PO Box 4174
Mountain View, CA 94040
1. MVPNS APPLICATION FOR ENROLLMENT 2016.pdf
2. MVPNS Committee/Job Sign Up Form (For Co-op classes only)
Parents are required to support the school in a role described in the MVPNS Committee/Job Sign-up Form. Please check at least one box out of each of the four groups then put a '1' by your preferred job and a '2' by your second preference.
3.MVPNS Work Day Preference Sheet (For Co-op classes only)
It is important that we know your preferences as soon as possible, so Class Schedulers can create the best work schedules possible. Parents are required to work 2-4 days per month (per participating child), with the exact number of days depending on your class (T/Th vs. MWF) and the class size.
Required by the California Department of Social Services for all classes
1. Identification and Emergency Information Spanish Version
“Names of Persons Authorized to Take Child from the Facility” are adults you designate, in your absence, to pick up your child from school. (Lic 700)
Update of Your Child's Immunization Records. Please note the requirements for California child-care facilities with regards to immunizations. A new requirement went into effect on January 1, 2016 where we can no longer accept a personal beliefs exemption (PBE) unless it was filed at a California child-care facility before January 1, 2016.
3. Child’s Pre-Admission Health History-Parent’s Report Spanish Version
List all allergies, including foods, drugs or environmental factors. (Lic 702)
4. Physician’s Report - Child Care Centers Spanish Version
Part B must be completed by child’s physician. A TB skin test is not required unless a child is identified to have risk factors as listed on the page 2 of this form. Be sure the physician completes this portion of the form before submittal. (Lic 701)
5. Health Screening Report - Facility Personnel Spanish Version
Form must be completed for each adult who will participate as workday volunteer with children at the school on a regular basis. Workday parent completes top half; physician completes bottom half of form. Health screening for adults must be performed not more than one year prior to enrollment. (Lic 503)
6. Tuberculosis Screening Documentation for Incoming MVPNS Families
TB test for work day volunteers (adults) must be completed betweenuly 1 and your first day of school in September (or within 60 days before the first day of class, if enrolling mid-year).
Please note that this must be completed within the above time frame and also even if a TB test has been completed previously. This is a requirement by the Santa Clara County Public Health Dept. for new family enrollment: “All employees/volunteers must have a TB Risk Assessment Questionnaire; TB testing based on the results of the TB risk assessment (no more than 60 days prior to initiation of employment/volunteering) and submit a signed Certificate of Completion.”
According to California Senate Bill 792, effective September 1, 2016, licensed child care programs are required to maintain vaccination records for influenza, pertussis and measles for their volunteers.
Influenza
We must have ONE of the following records for each volunteer:
1. A copy of an immunization record for influenza dated between August 1 and December 1 of each year.
2. A statement from the volunteer’s physician that there is a medical reason not to vaccinate the volunteer.
3. A statement from the volunteer’s physician that the volunteer is already immune to influenza .
4. A signed statement from the volunteer stating they have declined to be vaccinated again the flu
Pertussis (Whooping Cough)
We must have ONE of the following records for each volunteer:
1. A copy of an immunization record for pertussis.
2. A statement from the volunteer’s physician that there is a medical reason not to vaccinate the volunteer.
3. A statement from the volunteer’s physician that the volunteer is already immune to pertussis.
Measles
We must have ONE of the following records for each volunteer:
1. A copy of an immunization record for measles.
2. A statement from the volunteer’s physician that there is a medical reason not to vaccinate the volunteer.
3. A statement from the volunteer’s physician that the volunteer is already immune to pertussis.
Emergency and Security Forms
Consent for Emergency Medical Treatment/Emergency Contact and Release Spanish Version
Two page form. Complete all of the information on both pages, even though the information is duplicated. The form eventually gets cut in half to be placed in two different locations for emergency purposes. Form authorizes relative or friend to pick-up your child from school, and provides consent for emergency medical care, if needed. (Lic 627)
Consent for Security Background Check
Required by Mountain View-Los Altos Adult Education. Form must be completed and signed by each parent or adult who will participate as a workday volunteer with children at school on a regular basis. Each adult is required to list a valid driver’s license or California ID number.
Automobile License and Liability Information (For Co-op classes only)
Mountain View Parent Nursery School’s insurance company requires drivers on field trips to carry a policy that provides Bodily Injury Liability coverage of $30,000 per individual and $60,000 per accident, or hold an umbrella policy. This information is part of your automobile insurance policy. An insurance card alone does not provide all the necessary information. An example of the required information is available in the forms section of mvpns.org.
1. Photocopy of current automobile insurancethat includes your name, dates of policy coverage, and automobile Bodily Injury Liability coverage.
2.Photocopy of current driver’s license(s).
If you have any questions regarding the above requirements, please send email to info@mvpns.orgor leave a message for Membership at (408)-883-KIDS.