Entering into a partnership with a Child Care Nurse Consultant (CCNC) through the Pre School Partnership Agreement is a significant step forward for child care business owners or directors aiming to enhance the health and safety standards within their establishments. This comprehensive PDF form serves as a formal agreement between the child care facility and the CCNC, ensuring mutual understanding and collaboration towards improving the care environment for children. Detailed within the form are crucial elements such as the identification of the child care business, including the business’s name, owner or director’s name, contact information, and the specific type of child care service provided, ranging from start-ups to various licensed or registered child care centers and homes. Moreover, it explicitly outlines the authorization granted to the CCNC for conducting health and safety consultation services. These services encompass a wide range of activities vital for maintaining a high-quality care setting, such as direct observation of the learning environment, personnel practices review, examination of health and safety policies, and assessments of safety hazards, among others. By signing this agreement, which remains effective for two years, child care providers commit to closely working with CCNCs, thus taking a proactive stance towards fostering a safer and healthier environment for the children under their care. The dual-copy nature of the document ensures that both the child care business and the CCNC retain a record of this partnership, highlighting its importance and formalizing the commitment on both sides.
| Question | Answer |
|---|---|
| Form Name | Pre School Partnership Agreement Pdf Download Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | child care business partnership, partnership day care business example, partnership daycare business, partnership agreement for a family child care business |
Child Care Business – Partnership Agreement
Dear Child Care Business Owner/Director: Please read and sign the following agreement prior to the visit by your Child Care Nurse Consultant. We look forward to working with you to improve the health and safety of children enrolled in your care. Thank you.
Child Care Nurse Consultant name ___________________________________ Telephone _________________
Name of Child Care Business __________________________________________________________________
Name of Owner/Director ______________________________________________________________________
Mailing Address _____________________________________ City ___________________Zip Code ________
Street Address if different than mailing address ___________________________________________________
Telephone Number ___________________________ Fax Number ___________________________________
Email Address _____________________________________________________________________________
Type of Business (Check ALL boxes that apply.): |
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DHS Licensed Child Care Center |
DHS Licensed Preschool |
Head Start or Early Head Start |
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Shared Visions Preschool |
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DHS Registered Child Development Home: In what level/category of child development home are you registered?
Registration Level: A |
B |
C |
Other; please specify: ______________________________________________________________________
Authorization for Child Care Nurse Consultant Services*
I (we), __________________________________________________ authorize the Regional Child Care Nurse
Name(s) of Director
Consultant ________________________________ and / or the Local Child Care Nurse Consultant
Name of Regional CCNC
________________________________ to provide health and safety consultation. I (we) have been informed and
Name of Local CCNC
consent to the consultation services which could include, but are not limited to, the following activities:
•Direct observation of learning environments indoors and outdoors
•Observation of practices carried out by personnel (example: diapering, feeding, sanitizing, supervision)
•Review of health and safety written policies
•Review of parent consent forms pertaining to health and safety of children
•Review of daily medication record forms
•Review of child injury/incident report forms
•Review of health and safety regulatory records
•Assessment of safety hazards indoors and outdoors
•Review and assessment of child and personnel immunization certificates
•Review and assessment of child health exam forms and parent statements
•Review and assessment of employee, substitutes, and volunteers health exam or personal health statement forms
•Other assessment (specify) _______________________________________________________________
Owner or Director Signature(s) _______________________________________________________________
Date ___________________
Child Care Nurse Consultant Signature _________________________________________________________
Date___________________
*This authorization is in effect for two calendar years from the date of Owner/Director’s signature.
Top copy remains with the child care business owner/director. Bottom copy returned to Child Care Nurse Consultant. FORM #:
Name of Business: __________________________