Ocfs Registration Form PDF Details

Are you ready to start the OCFS registration process? Whether you're a first-time registrant or an experienced professional, getting your paperwork in order is an important step for any race series. While the exact structure of each driver's packet varies from track to track, there are some common requirements that must always be addressed when filling out your form. In this article, we'll take a look at exactly what forms should be included with your OCFS registration and how to fill them out correctly. Read on to make sure every detail of your application is up-to-date so that you can get behind the wheel as quickly as possible!

QuestionAnswer
Form NameOcfs Registration Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnys ocfs scr form, ocfs ldss 0792 daycare registration, ocfs registration form, ldss ocfs 0792

Form Preview Example

OCFS-LDSS-0792 (1/2005) FRONT

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?

 

 

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-care provider.

Child’s Source of Medical Care/Primary Care Physician’s Name:

Telephone Number:

 

 

Child’s Source of Dental Care/Dentist’s Name:

Telephone Number:

 

 

Name Of Medical Care Facility/Hospital:

Telephone Number:

 

 

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:

 

DATE OF DISCHARGE:

 

 

 

 

 

 

 

NAME OF PERSON APPLYING FOR CHILD:

Parent

Guardian

HOME TELEPHONE NUMBER:

 

 

 

Caretaker

Relative

 

 

DAYTIME TELEPHONE NUMBER:

 

Other

 

 

 

 

 

 

 

ADDRESS OF PERSON LISTED ABOVE: (IF DIFFERENT FROM CHILD’S):

 

 

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 well-being of my

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

 

No

I agree to review and update this information whenever a change occurs and at least once every six months.

Yes

No

 

 

 

 

SIGNATURE – PARENT OR PERSON(S) LEGALLY RESPONSIBLE

DATE:

 

 

 

 

 

 

OCFS-LDSS-0792 (1/2005) REVERSE