Children’s Application

To be completed, signed, and placed on file in the facility on the first day and updated as changes occur and at least annually.

Child will be release only to the parent/guardians listed above. The child can also be release to the following individuals, as authorized by the person who signs this application.

In the event of an emergency, if the parents/guardians cannot be reached, the facility has permission to contact the following individuals.

For any child with health care needs such as allergies, asthma, or other chronic condition that require specialized health services, a medical action plan shall be attached to the application. The medical action plan must be completed by the child's parents or health care professional. 

I, as the parent/guardian, authorize the center to obtain medical attention for my child in an emergency.

I, as the operator, do agree to provide transportation to an appropriate medical resource in the event of emergency. In an emergency situation, other children in the facility will be supervised by a responsible adult. I will not administer any drug or any medication without specific Instructions from the physician or the child's parents, guardian, or full-time custodian.