Name: Gender: Birthdate: Classroom:
Home Language: Ethnicity/race: School Year:
Enrollment Date:
T
iny Tots Development Center Where loving care comes first
8318 Renton Avenue South, Seattle WA 98118 (206)723-1456
www.tinytotsdc.org info@tinytotsdc.org
Tiny Tots Development Center Enrollment Application
Parent/Guardian 1
Relationship
Telephone
Landline Cell
Work Phone
Street Address
City State Zip
Email/other
Employer
Parent/Guardian 2
Relationship
Telephone
Landline Cell
Work Phone
Street Address
City State Zip
Email/other
Employer
Authorized/Emergency Contacts (to be contacted and to whom child may be released if guardian is unavailable)
Name
Relationship
Telephone
Landline Cell
Work Phone
Street Address
City State Zip
Name
Relationship
Telephone
Landline Cell
Work Phone
Street Address
City State Zip
Out-of-State Emergency Contact (in case of a natural disaster)
Name
Relationship
Telephone
Landline Cell
Work Phone
Street Address
City State Zip
Preferred sources of medical care for your child
Physician’s name
Telephone
Clinic Name
Fax
Address
City State Zip
Dentist’s name
Telephone
Clinic Name
Fax #
Address
City State Zip
Clinic/Hospital
Telephone
Address
City State Zip
Child’s Health/Dental Insurance (please check type of coverage)
CHIP CHP Medicaid (Healthy Options) Plan WA Basic
Health Plus Private Insurance
ID#:
S
pecial Conditions, Disabilities, Allergies or Medical Emergency Information:
PARENT/GUARDIAN CONSENT AND AGREEMENT FOR EMERGENCIES
As a parent/guardian, I consent to have my child receive first aid by facility staff and, if necessary, be transported to receive
emergency care. I will be responsible for all charges not covered by insurance. I give consent for the emergency contact person
listed above to act on my behalf until I am available. I agree to review and update this information whenever a change occurs
and at least every program year.
Parent/Guardian signature Date:
First
Last
Name: Gender: Birthdate: Classroom:
Home Language: Ethnicity/race:
School Year: Enrollment Date:
Tiny Tots Development Center Where loving care comes first
8318 Renton Avenue South, Seattle WA 98118 (206)723-1456
www.tinytotsdc.org info@tinytotsdc.org
Hold Harmless Agreement
I understand the policy of Tiny Tots Development Center and understand that TTDC shall have
no responsibility for its employees who have contact outside regular program hours with my
child(ren):
I agree that Tiny Tots Development Center shall not be liable for any injury, trauma, stress,
or death of any person or damage to any property which its employee may cause
while caring
for my child(ren) outside of regular Tiny Tots Development Center program hours. I agree
to
indemnify and save Tiny Tots Development Center harmless from any and all claims,
costs
and expenses whatsoever arising out of any such injury or damage.
Parent/Guardian signature Date:
East Campus Wing Luke
TTDC Main Hutchinson
Name: Gender: Birthdate: Classroom:
Home Language: Ethnicity/race:
School Year: Enrollment Date:
Tiny Tots Development Center Where loving care comes first
8318 Renton Avenue South, Seattle WA 98118 (206)723-1456
www.tinytotsdc.org info@tinytotsdc.org
Volunteer Application
Parent Community Member
Site: Main Campus East Campus Wing Luke Hutchinson
Contact Information
Name
Relationship
Telephone
Work Phone
Street Address
City State Zip
Email/other
My Emergency Contact Information
Name
Relationship
Telephone
Work Phone
Street Address
City State Zip
Email/other
What is the best time to contact you? Morning (8-12am) Afternoon(12-4pm) Evening(4-
6pm)
Y
N
Are you interested in serving on the ECEAP policy and decision-making
council?
Do you need any special accommodations, or do you have a disability?
Do you have a car?
Do you take the bus?
How can you help?
Working/Assisting
in the Classroom
Music
Cooking
Artwork
Storytelling
Planning Events
Field Trips
Translation
Language:
Fundraising
Classroom Activities
Office Work
Advocacy
Other:
Name: Gender: Birthdate: Classroom:
Home Language: Ethnicity/race:
School Year: Enrollment Date:
Tiny Tots Development Center Where loving care comes first
8318 Renton Avenue South, Seattle WA 98118 (206)723-1456
www.tinytotsdc.org info@tinytotsdc.org
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand
that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made
by me on this application may result in my immediate dismissal.
Printed Name of Volunteer:
Volunteer signature Date:
If volunteer is a minor:
Printed Name of Parent/Guardian:
Parent/Guardian signature Date:
Volunteer Waiver
I fully understand and agree to assume all risks involved in any and all duties that I perform in a
volunteer capacity on behalf of or in connection with Tiny Tots Development Center (TTDC). I
agree to hold Tiny Tots Development Center and its employees and volunteers harmless for any
injury(s), loss or damages which I might sustain during my volunteer duties.
This waiver includes myself, all my family members and descendants forever from seeking any
legal action whatsoever against the Tiny Tots Development Center or its successor
organizations or any representatives thereof.
Printed Name of Volunteer:
Volunteer signature Date:
If volunteer is a minor:
Printed Name of Parent/Guardian:
Parent/Guardian signature Date:
Please note:
This agreement must be signed by ALL volunteers before performing any services relating to activities of TTDC. This
includes, but is not limited to, rescue contact persons, foster caretakers, transport volunteers, and fund-raising
volunteers.
Please sign the agreement and send it by mail or FAX or deliver in person to the TTDC representative you are
working with.
Name: Gender: Birthdate: Classroom:
Home Language: Ethnicity/race:
School Year: Enrollment Date:
Tiny Tots Development Center Where loving care comes first
8318 Renton Avenue South, Seattle WA 98118 (206)723-1456
www.tinytotsdc.org info@tinytotsdc.org
Public Code of Conduct
Welcome to Tiny Tots Development Center! In order to ensure that we provide a safe atmosphere, the TTDC Board
of Directors has approved the following code of conduct.
The behaviors listed below are not acceptable at any TTDC childcare site, administrative office, meeting, or event,
and will not be tolerated.
Engaging in any activity prohibited by law.
Disruptive or unsafe behavior which interferes with the use of the facilities by others or with the staff’s ability
to function. This includes, but is not limited to:
Loud, abusive, threatening, harassing or insulting language toward staff, children, parents or other persons.
Any sexual misconduct such as exposure, staring, inappropriate touching, or sexual language.
Activities or behavior that may result in damage, abuse or theft of TTDC property.
Petitioning, soliciting, gambling, advertising or selling merchandise without the express permission of the
Executive Director.
Playing any audio equipment or device at a level which can be heard by others.
Verbal or physical fighting.
Stalking or invading another person’s physical space.
Entering any TTDC child care site or administrative office with any firearm, knife or other weapon prohibited
by City Ordinance or State Statutes.
Use of skates or skateboards on TTDC property.
Refusal by adults over 18 years of age to leave any TTDC facility when asked.
By signing this agreement, you also promise not to engage in any of the following inappropriate personal behaviors
while on the premises of any Tiny Tots site, including, but not limited to:
Sleeping.
Smoking.
Personal bathing or washing of clothes or personal items.
Lack of shirt or shoes.
Spitting.
Poor personal hygiene which is offensive and bothersome to others.
Leaving personal belongings, including cars, bicycles, motorcycles, or other vehicles unattended in any
TTDC building or on TTDC grounds.
Being intoxicated with alcohol or drugs or in possession of any intoxicating drug or alcoholic substance in
any TTDC building or on TTDC grounds.
Urinating or defecating anywhere on TTDC property, other than in public restroom facilities.
Entering any TTDC building with animals, birds or vehicles (not including wheelchairs), except as required by
persons with disabilities who are in possession of official certification for the animal.
Tiny Tots Development Center reserves the right to limit access to any TTDC site, or to suspend or terminate access
to childcare for repeated failure to comply with this Code of Conduct. We appreciate your cooperation with this
code of conduct. Anyone violating the code will be warned by staff and/or security. If the conduct continues, the
offender will be asked to leave, or staff may call police. Anyone can be expelled from a TTDC building without
warning in situations of serious, threatening, or willfully malicious behavior. If you have any questions or concerns,
please feel free to contact your Program Director at the childcare site.
Parent/Guardian signature Date:
Enrollment Specialist signature Date:
Name: Gender: Birthdate: Classroom:

HomeLanguage: Ethnicity/race:
 SchoolYear: EnrollmentDate:

TinyTotsDevelopmentCenterWherelovingcarecomesfirst
8318RentonAvenueSouth,SeattleWA98118(206)723‐1456
www.tinytotsdc.orginfo@tinytotsdc.org
Parent/Family Consent Form
I give my permission for to participate in the following
services/activities, where I have signed my initials, while s/he is enrolled in any Tiny Tots Development
Center programs. Each service/activity is designed to enhance your child’s participation in the program
Initials: Item:
I have read or have had this consent form explained/translated for me and I understand it; I consent to my child
participating in/receiving those activities or services where I have signed my initials above. I understand that I
have rights of access to all the above records.
Parent/Guardian signature Date:
Enrollment Specialist signature Date:
To be transported on program field trips about which I have been notified.
To be photographed or video-taped for educational purposes and advertising
ECEAP through various mediums e.g. Internet, Facebook, fliers, brochures.
To transport my child to and from the program (if such services are available).
To receive a developmental screening – Ages and Stages
To receive dental screenings (if such services are available).
To receive weight and height screenings.
To receive hearing screenings
To receive vision screenings
To receive the Teaching Strategy Gold child assessment portfolio
To use fluoride toothpaste for teeth brushing
Authorization of the release of records (Kindergarten All About Me report and other
confidential information as needed) to School Districts and related parties working in
partnership with Tiny Tots Development Center. I release these records for use in the
enhancement of my child’s education. I understand that all such information will be
handled with strict attention to privacy.
Name: Gender: Birthdate: Classroom:
Home Language: Ethnicity/race:
School Year: Enrollment Date:
Tiny Tots Development Center Where loving care comes first
8318 Renton Avenue South, Seattle WA 98118 (206)723-1456
www.tinytotsdc.org info@tinytotsdc.org
Acknowledgement of Receipt of Family Handbook
Acknowledgement of Responsibility for Payments
I acknowledge that I have received the Tiny Tots Development Center Family Handbook and agree
to the terms indicated therein.
I understand that I am responsible for reading the content of the family handbook, and for abiding
by the policies of Tiny Tots Development Center. I understand that the handbook contains the
following policies, among others, and that it is my responsibility to review and understand the policies.
I also understand that policies are subject to change without notice.
Admission requirements
Attendance policy
Termination of services
Late fee policy
Late child pick-up policy
Pesticide policy
Sign-in / Sign-out
Health and nutrition policies
Hold harmless agreement
Emergency/snow, presence of
fish tank on site, and natural
disasters policy
Consent to medical care
Code of conduct
I further acknowledge that I am responsible for all payments entitled to Tiny Tots Development
Center, either paid directly by me or through any sponsored program. If I fail to re-qualify for
any sponsored program, I remain responsible for the full balance of any payment owed to:
Tiny Tots Development Center.
Printed Name of Parent/Guardian:
Parent/Guardian signature Date:
Printed Name of Enrollment Specialist:
Enrollment Specialist signature Date:
Name: Gender: Birthdate: Classroom:
Home Language: Ethnicity/race:
School Year: Enrollment Date:
Tiny Tots Development Center Where loving care comes first
8318 Renton Avenue South, Seattle WA 98118 (206)723-1456
www.tinytotsdc.org info@tinytotsdc.org
Frequently Asked Questions Billing and Payments/EFT Agreement
PAYMENT POLICIES- Please Initial each item in the space provided
Is there a Security Deposit or Registration Fee?
Yes
Tiny Tots requires a $75 Security Deposit.
Annual $50 registration applies to Private Rate Families and
City of Seattle Subsidy Families
.
Is my Deposit Returned when I withdraw from the Center?
Yes, the following exceptions APPLY:
Any payment plans
Any late/returned payments
Abusing the late pick up policy
Any special promotions or Scholarships are granted to you
Withdrawing from Tiny Tots Development Center with less than 12
consecutive months of care
Failure to give 30 days’ written notice of your child’s last day at Tiny
Tots Development Center
.
If you do not return your Withdrawal form to the
Administration Building by fax 206 723 7239, by email
fcarter@tinytotsdc.org, or in person to the Helen Hicks
Building 8318 Renton Ave S Seattle, WA 98118, YOUR
PAYMENT WILL CONTINUE TO BE PROCESSED. Please do not
assume you are withdrawn from our program if these steps
have not been accomplished.
Type of Payments Accepted?
Payments are accepted via Credit/Debit Card or Automatic
Bank Transfers. We do not accept cash, or check, or money
orders.
When are Payments due?
Payment for the first month of Tuition, deposit and annual
registration is due in full before the start date.
You must choose a payment date between the 1
st
and 20
th
of the
Initials
Initials
Initials
Initials
Name: Gender: Birthdate: Classroom:
Home Language: Ethnicity/race:
School Year: Enrollment Date:
Tiny Tots Development Center Where loving care comes first
8318 Renton Avenue South, Seattle WA 98118 (206)723-1456
www.tinytotsdc.org info@tinytotsdc.org
month. We will automatically withdraw your payment on the day
you specify. If your payment date falls on a weekend or a holiday,
the transaction will be processed on the next business day.
Please be consistent with your payment date. We require 30
days’ notice if you need to change your payment date. We
cannot cancel a payment on the date of payment (Example:
process date is the 5
th
of the month. Can NOT make changes on
the 5
th
)
What happens if my payment is returned for NFS?
There is a $45 fee for declined payments.
If your balance is not paid by the last business day of the month you will
be charged a $75 LATE FEE and 18% INTEREST FEE on the balance due.
If your payment declines, we will process your payment for the full
balance on your next regularly scheduled payment date.
We will NOT carry accounts with balances greater than 30 days. Tiny Tots is registered with a
Collection Agency for delinquent funds. DSHS or the City’s client case manager will be notified
if your account is forwarded to collections.
IF YOU HAVE TWO DECLINED PAYMENTS, YOU WILL BE NOTIFIED BY
ADMINISTRATION STAFF, IF YOU CONTINUE TO HAVE DECLINED PAYMENTS YOUR
CHILDCARE SERVICES WITH TINY TOTS ARE SUBJECT TO TERMINATION.
BILLING POLICIES- Please Initial each item in the space provided
Subsidy Billing: Parents receiving subsidy award letters from DSHS or the City of Seattle
are responsible for obtaining these in a timely manner. If your subsidy expires and we
do not have a current one on file, we WILL bill according to regular tuition rates.
What are the billing rates?
Tiny Tots Development Center Rates
Age
Monthly
Rate
Daily Rate
Infant (Up to 11 months)
$ 1,965.24
$89.34
Toddler (12-29 months)
$ 1,755.36
$79.82
Pre-School (over 30 months)
$ 1,440.54
$65.51
ECEAP Services (Enhanced
Preschool)
$ 1,192.88
No Daily
Rate
Initials
Initials
Initials
Name: Gender: Birthdate: Classroom:
Home Language: Ethnicity/race:
School Year: Enrollment Date:
Tiny Tots Development Center Where loving care comes first
8318 Renton Avenue South, Seattle WA 98118 (206)723-1456
www.tinytotsdc.org info@tinytotsdc.org
Before School
$ 491.12
$22.32
After School
$557.52
$25.33
Before and After School
$884.93
$40.22
Summer School Age
$1,041.77
$47.53
EFFECTIVE 09/01/2018 ***Rates subject to change annually***
Parent/Guardian signature Date:
Enrollment Specialist signature Date:
Electronic Transfer Funds Agreement
Processed through Tuition Express
Parent Name: Monthly Processing Date:_______
Billing Address: Billing Zip:______________________
Card Number: Expiration Date: __________CID:______
or
Routing Number: ____________________Account Number: _____________________________
I (we) hereby authorize Tiny Tots Development Center to initiate debit entries to my (our)
Credit/Debit or checking/savings Account indicated below. To properly affect the
cancellation of this agreement, I (we) are required to give 10 days’ written notice.
Parent/Guardian signature Date:
Enrollment Specialist signature Date: