Acknowledgement of Paperwork
Enrollment Date: __________________________
Trial Period Ends: _________________________
Full Contract Effective Until: ______________________
Child’s Name: ______________________________________ Child’s Birthdate: _______________________
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Form Title: |
(Please Date and Initial) Received Did NOT Receive |
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By Parent |
By Pam Ball |
By Parent |
By Pam Ball |
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Child’s Biography |
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Child Health Status Report – must be returned, signed by a licensed health care provider by: _________ |
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Parent Handbook |
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Financial Contract |
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Holiday & Vacation Schedule |
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Illness & Medical Policy |
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Permission to Transport |
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Permission to Participate in Activities |
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Permission to Photograph |
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Release of Child |
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Consent for Medical Treatment (3 copies) |
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Permission to Administer Medication in Child Care (3 copies) – Please keep these in the glove compartment of your car for trips to the doctor. More will be provided upon request. |
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Permission to Administer Over-the-Counter Medications |
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Immunization Record |
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Food Program Child Enrollment Form |
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Other (Please list): |
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By signing below, I/We acknowledge receipt of the above listed forms, and agree to abide by the terms and policies as outlined in them.
(Mother/Guardian) (Date)
(Father/Guardian) (Date)
(Pamela Ball) (Date)