Enrolling a child in day care is an important step that involves careful consideration and detailed planning. The New York State Office of Children and Family Services (OCFS) Registration Form plays a crucial role in this process, ensuring that all necessary information about a child is communicated effectively to the day care provider. The OCFS Registration Form, also known as OCFS-LDSS-0792, is comprehensive, covering aspects from basic identification details like the child's full name, home address, and date of birth, to more specific health-related information. It seeks to gather data on any allergies the child may have, their medical and dental care providers, as well as details on special health care needs, highlighting the state's commitment to inclusive care for all children. Moreover, the form includes sections on emergency data, showcasing the importance of having readily available contact information in the event of an incident. Consent clauses are also integral to the form, emphasizing the parent's or guardian's agreement to the policies of the day care facility, emergency medical procedures, and the sharing of pertinent health information with the provider. This ensures a shared understanding and preparedness among all parties involved for the child's safety and well-being. As such, the OCFS Registration Form is not only a bureaucratic necessity but a tool for fostering a safe and nurturing environment for children in day care.
| Question | Answer |
|---|---|
| Form Name | OCFS Registration Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | nys ocfs scr form, ocfs ldss 0792 daycare registration, ocfs registration form, ldss ocfs 0792 |
PHOTO OF CHILD
(Optional)
NEW YORK STATE
OFFICE OF CHILDREN AND FAMILY SERVICES
DAY CARE REGISTRATION
Child’s Full Name:
Does your child have any allergies? |
Yes |
No |
If Yes, what is your child allergic to? |
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Children who have special health care needs are those who have chronic physical, developmental, behavioral or emotional conditions expected to last 12 months or more and who also require health and related services of a type beyond that required by children generally. If your child does have special health care needs please discuss these with your
Child’s Source of Medical Care/Primary Care Physician’s Name: |
Telephone Number: |
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Child’s Source of Dental Care/Dentist’s Name: |
Telephone Number: |
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Name Of Medical Care Facility/Hospital: |
Telephone Number: |
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Would you like information on Child Health Plus? Yes
No
EMERGENCY DATA
RELATIONSHIP |
CONTACT NAME |
TELEPHONE NUMBER DURING CHILD CARE OTHER TELEPHONE NUMBER (Check type) |
Pager
Cell
Other
Pager
Cell
Other
Pager
Cell
Other
Pager
Cell
Other
CHILD’S FULL NAME:
CHILD’S HOME ADDRESS:
SEX: Male
Female
DATE OF BIRTH:
HOME TELEPHONE NUMBER:
Provider/Day Care Facility Name and Address:
DATE OF ACCEPTANCE: |
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DATE OF DISCHARGE: |
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NAME OF PERSON APPLYING FOR CHILD: |
Parent |
Guardian |
HOME TELEPHONE NUMBER: |
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Caretaker |
Relative |
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DAYTIME TELEPHONE NUMBER: |
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Other |
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ADDRESS OF PERSON LISTED ABOVE: (IF DIFFERENT FROM CHILD’S): |
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AGREEMENTS
I consent to the enrollment of the child listed above in this facility and have been advised of the policies regarding administration of medications, fees, transportation and the services provided by the facility, and the Office of Children and Family Services regulations under which it operates.
I give consent for my child to take part in neighborhood trips (i.e. library, park and playground) away from the facility under proper
supervision. |
Yes |
No |
In case of accident or injury, I authorize any and all emergency medical, dental, and /or surgical care and hospitalization advised by the physicians, surgeon or hospital (listed on the other side of this card) necessary for the proper health and
child. |
Yes |
No |
I have provided information on my child’s special needs (Allergies, Diet, Disabilities, and /or Medical Information) to the provider,
as may be necessary to assist the facility in properly caring for my child in case of an emergency. |
Yes |
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No |
I agree to review and update this information whenever a change occurs and at least once every six months. |
Yes |
No |
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SIGNATURE – PARENT OR PERSON(S) LEGALLY RESPONSIBLE |
DATE: |
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