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􀂅 YES* 􀂅 NO *If yes, please complete an allergy care plan. |  |  |  |  |  |  |  |  |\n| Parent or Guardian Contact Information |  |  |  |  |  |  |  |  |  |\n| Name (First, Last) |  |  |  |  |  |  | Relationship |  |  |\n| Home Address (Street, City, Zip) |  |  |  |  |  |  |  |  |  |\n| Home Phone |  | Cell Phone |  |  | Email Address |  |  |  |  |\n| Employer and Work Hours |  |  |  | Work Address (Street, City, Zip) |  |  |  |  | Work Phone |\n| Name (First, Last) |  |  |  |  |  |  | Relationship |  |  |\n| Home Address (Street, City, Zip) |  |  |  |  |  |  |  |  |  |\n| Home Phone |  | Cell Phone |  |  | Email Address |  |  |  |  |\n| Employer and Work Hours |  |  |  | Work Address (Street, City, Zip) |  |  |  |  | Work Phone |\n| Required Emergency Contact Information-person other than parent or guardian that is authorized to pick up child |  |  |  |  |  |  |  |  |  |\n| Name (First, Last) |  |  |  |  |  | Phone | Relationship |  |  |\n| Name (First, Last) |  |  |  |  |  | Phone | Relationship |  |  |\n| Non‐Emergency Contact Information-person other than parent or guardian that is authorized to pick up child |  |  |  |  |  |  |  |  |  |\n| Name (First, Last) |  |  |  |  |  | Phone | Relationship |  |  |\n| Name (First, Last) |  |  |  |  |  | Phone | Relationship |  |  |\n| Medical Contact Information |  |  |  |  |  |  |  |  |  |\n| Insurance Provider and Policy Information (if applicable) |  |  |  |  |  |  |  |  |  |\n| Child's medical provider(s) or emergency care facility |  |  |  |  |  |  | Phone |  |  |\n| Parent or Guardian Authorizations (not all of these authorizations are required in family child care) |  |  |  |  |  |  |  |  |  |\n| Please list any restrictions to permission of the following:\u003Cbr>My child may be taken on field trips or excursions by bus or private motor vehicle, as well as on neighborhood walking excursions under required supervision 􀂅 Yes 􀂅 No Note: A signed permission slip is required for all field trips out of the neighborhood.\u003Cbr>My child may use sunscreen 􀂅 Yes 􀂅 No My child may apply their own sunscreen under adult supervision. 􀂅 Yes 􀂅 No\u003Cbr>My child may be photographed and/or recorded for publicity or news purposes: 􀂅 Yes 􀂅 No This applies to: 􀂅 On‐site 􀂅 Off‐site photography and video.\u003Cbr>CC/SC/ONB: my child may participate in religious or cultural events described in center policy, including special occasions where food is being served. 􀂅 Yes 􀂅 No\u003Cbr>CC/SC only: I have reviewed a copy of this child care facility’s current license certificate. 􀂅 Yes 􀂅 No I have received a written copy of the program’s child care policies. 􀂅 Yes 􀂅 No\u003Cbr>In an emergency, the child care facility has my permission to call an ambulance or transport my child to any available physician or hospital at my expense to obtain medical treatment. In most emergencies, 911 is called and the child is transported to the nearest hospital and treated by the on‐call physician. The parent or guardian of the child must be notified as soon as possible. |  |  |  |  |  |  |  |  |  |\n| Date: Parent/Guardians Signature: |  |  |  |  |  |  |  |  |  |\n\n\n| Has your child previously been in child care? 􀂅 Yes 􀂅 No If yes, what type of care and for how long? |  |  |\n| --- | --- | --- |\n| Child General Information – please include any information that will assist us in providing quality care for your child |  |  |\n| General likes and dislikes |  |  |\n| Eating habits and schedule |  |  |\n| Sleeping habits and schedule |  |  |\n| Developmental and health history that could affect the child's participation in child care |  |  |\n| Interactions with other children |  |  |\n| How does your child like to be comforted? |  |  |\n| Child’s home language |  |  |\n| Are there family cultural backgrou","cbCaibouUqhlzN8N","https://ap.wps.com/l/cbCaibouUqhlzN8N","pdf",188340,"English","# Child and Contact Details\n## Allergy and Medical Information\n## Parent or Guardian Authorizations\n## Child General and Medical History\n## Other Children in the Home\n## Annual Review and Sign-off","[{\"question\":\"What sections are required for the child’s identity and allergies?\",\"answer\":\"The form includes the child’s name, date of birth, nickname, date entered care, and an allergy alert section with Yes/No and an allergy care plan requirement when applicable.\"},{\"question\":\"Who must be listed for emergency and non-emergency pickup authorization?\",\"answer\":\"It requires emergency and non-emergency contact information for individuals other than a parent or guardian who are authorized to pick up the child, including names, phone numbers, and relationship.\"},{\"question\":\"What authorizations can parents provide for activities and emergencies?\",\"answer\":\"Parents can grant or deny permissions for field trips, sunscreen use (including self-application with adult supervision), photography/video publicity, participation in religious or cultural events, and emergency permission to call an ambulance or transport the child for medical treatment.\"}]","Child Enrollment Form - Sign-off and Annual Review | PDF"]