Brooklyn Children Learning Academy(BCLA) Toggle NavigationHomeProgramsAbout BCLAApply OnlineParent Daily Health Attestation FormEmployee Daily Health Attestation FormHomeProgramsAbout BCLAApply OnlineParent Daily Health Attestation FormEmployee Daily Health Attestation Form Free EarlyLearn and 3-KServices Available ENROLL FREE TODAY! Get ahead of the crowd and complete our online application. An enrollment specialist will be in contact with you as soon as possible. Child's Name*Child's DOB*Child’s GenderSelect OneFemaleMaleI prefer not to sayChild’s Current Address*Child’s Current Address Line 2*Parent/ Guardian's Name*Parent/ Guardian’s GenderSelect OneFemaleMaleI prefer not to sayParent 1 DOB*Parent 1 Current Address (if different from above)Parent 1 Current Address Line 2Parent/ Guardian Email Address*Parent / Guardian Phone*Parent 1 Occupation*Parent 1 Employer's Name*Parent 1 Work Address*Parent 1 Work Address Line 2*Parent 1 Work Phone*Method of Transportation*Select OneBusCarTrainWalkOtherParent/ Guardian 2 (Optional)Parent 2 GenderSelect OneFemaleMaleI prefer not to sayParent 2 DOBParent 2 Current Address (if different from above)Parent 2 Current Address Line 2Parent 2 Email AddressParent 2 Primary PhoneParent 2 OccupationParent 2 Employer's NameParent 2 Work Address Line 1Parent 2 Work Address Line 2Parent 2 Work NumberParent 2 Method of TransportationSelect OneBusCarTrainWalkOtherDays Care is Needed*Check all that apply:MondayTuesdayWednesdayThursdayFridayMonday*Expected drop off and pick up time. Type None if care isn't needed that day.Tuesday*Enter expected drop off and pick up timeWednesday*Enter expected pick up and drop off timesThursday*Enter expected drop off and pick up timesFriday*Enter expected drop off and pick up timesAre you interested in financial assistance for childcare? Choose OneYesNoI have a voucher alreadyPlease include information regarding your child’s and/or family tradition and culture. Does your child have any allergies should be aware of? Please include the symptoms during contact and emergency techniques. *Is there any medical diet restriction we should know about? Please attach medical statement from a pediatrician/ doctor. *Please list any health conditions we should be aware of*If none, type n/aIs your child on a daily medication regimen we should know about *BCLA Directors are trained to administer medication if needed. YesNoIf yes, please tell us the name, strength, dose and frequency of each medication. *If no please type n/aEmergency Contact Information *Please add the information of the person to contact during emergencies if one of the parent or guardians cannot be reached. Relationship to Child *Phone(xxx) xxx-xxxxEmail AddressPermission to pick up child? *YesNoEmergency Contact 2 *Please list the name of someone else you’d like to be contacted during emergencies of the guardians and/ or emergency contact 1 cannot be reached. Relationship to Child *Phone Number (xxx) xxx - xxxxEmail Address 2Permission to pick up child? *YesNoIs there anyone who should not have access to the child? *YesNoIf yes, please list full names below. If no, please type n/a*Do you give BCLA permission to use photos and/or video of your child for the reasons explained below? *BCLA use photos and videos to record student progress and create portfolios for the center. Recorded material may be used for advertisement and display purposes, including but not limited to marketing, website, fundraising and other marketing outlets. For your child’s protection no personal information will be given/shared from these recorded material.YesNoDo you agree to have your child join us for our daily outside activities? *BCLA take children out daily for short walking trips to the neighborhood playground. We also take our children on neighborhood nature walks. Please note if you answer no, your child will stay inside with one of our Directors during outside play and will resume to class when the teacher returns. YesNoDo you agree to BLCA Sleeping policy and arrangement. *All children ages 2- 4 will sleep on a cot with a sheet and a blanket. Children ages 1 will sleep on a May with a sheet. Infants will sleep on a crib/ pack n play. Toys/ pillows are not permitted when children are sleeping. Sleeping arrangements for infants require that the infant be placed on his or her back to sleep, unless medical information is presented to the provider by the parent that shows that this arrangement is inappropriate for that child. A Teacher or Director must be present at all times when children are asleep. No child is left unattended while sleeping. All infant will require a sleep log to check for breathing every 15 min during sleep time. YesNo Will you need transportation service for you child? * If yes, a Director will determine eligibility, arrangement and payments during enrollment. YesNoIf you chose yes, which situation applies to you? A Director will review this information and determine eligibility, arrangements and payment. My child is between 6 weeks and 4 years and I need pickup and drop off service between home and BCLA.My child is age 4-12, in school and will only need to be picked up from school to BCLA center. A guardian will pick up my child from BCLA.My child is ages 4-12, in school and will need to be picked up from school to BCLA center and dropped off homeMy child is age 4-12 and will take the school bus to BCLA from school and will be picked up by a guardian.My child is age 4-12 and will take the school bus to BCLA from school and will need to be dropped off home from BCLANone of the aboveParent/ Guardian Electronic Signature*By signing below, I certify that everything written on this form is true and to the best of my knowledge. Parent/ Guardian 2 Electronic Signature (optional)By signing below, I certify that everything written on this form is true and to the best of my knowledge. This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.EnrollThank you for choosing BCLA for your childcare needs! We are honored to serve families of essential employees during this unprecedented time. Our Enrollment Specialist will contact you with the necessary documents to begin your enrollment process. Please keep in mind that we will determine eligibility for care by the guidelines presented by Governor Andrew Cuomo as New York State list which occupations are considered essential. Please visit the link below to view the list of essential employees. https://www.governor.ny.gov/news/governor-cuomo-issues-guidance-essential-services-under-new-york-state-pause-executive-order If you are not considered an essential employee by law, you will be placed on a waitlist and we will keep you updated on the status of your enrollment as we await for city updates concerning plans for New York City to open back up. We send our sincerest apologies for any inconvenience. Thank you and welcome to BCLA! / PreviousNextPausePlayClose