Daycare Contracts And Forms Details

Printable daycare forms can be extremely helpful in providing a smooth and stress-free experience when arranging for child care. This type of form is typically provided by the daycare center, and it outlines all of the necessary information pertaining to your child's stay. By having a copy of this form ahead of time, you can ensure that all of your questions are answered and that you have everything you need to drop your child off confidently. Printable daycare forms usually include the following information: emergency contact information, policies and procedures, health history, medication authorization (if applicable), dietary restrictions (if applicable), and anything else specific to your child's care.

Here, you'll find a number of information about printable daycare form PDF. This figure can provide information regarding the form's length, finalization time, and the areas you may be expected to fill.

QuestionAnswer
Form NamePrintable Daycare Form
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namesdrop in forms for daycare, daycare blank forms, daycare forms, printable daycare enrollment forms

Form Preview Example

 

 

*P H O T O OF C H I L D

 

FAMILY CHILD CARE

(*Optional)

Children’s Records must

P L U S

five (5) years after a child

ENROLLMENT PACKET

P H Y S I C A L

be maintained for at least

F A C E S H E E T

 

has left the program

D E S C R I P T I O N

 

 

 

Eye Color _______

Please fill out these forms completely. If a question does not apply

Hair Color ______ Sex_____

to your child, write N/A (not applicable). The forms must be in the

Height _____ Weight _______

educator’s possession on or before the first day your child begins

Other:____________________

care. Please notify your educator if any of the information changes.

_________________________

 

 

General Information

_________________________

Date of Admission ________________ Age at Admission: ______

 

 

Date of Discharge ______________

Reason for Discharge: _________________________________________________________________

____________________________________________________________________________________

Child's full name ______________________________Date of Birth ______________________________

Address:_______________________________

City:___________________ Zip:________________

Telephone Number: ______________________________ Nickname __________________

Primary Language of Child _____________

Primary Language of Parents_________________

Allergies/Special Diets _________________________________________________________________

Name of Parent(s)/Guardian(s)___________________________________________________________

Home address (if different) ______________________________________________________________

Telephone Number:____________________________________________________________________

Email Address: _______________________________________________________________________

Parent(s)/guardian(s) business address/location during child care:

Parent/Guardian: __________________________

Parent/Guardian ____________________________

Where: __________________________________

Where: ___________________________________

Telephone: _______________________________

Telephone:_________________________________

Cell Phone: _______________________________

Cell Phone:________________________________

Instructions: _______________________________

Instructions:________________________________

_________________________________________ __________________________________________

Emergency Contact/Authorized pick-up person

In the event of an emergency when I may not be reached, the Educator may contact the following individuals (in the order given) whom I authorize to take my child from the child care premises.

(1)Name: _______________________________ Address _____________________________________

Telephone ______________Cell Phone __________

(2)Name: ______________________________ Address ______________________________________

Telephone _____________ Cell Phone __________

 

Child’s Name ______________________

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TRANSPORTATION PLAN / AUTHORIZED PICK- UP

My child will arrive to the program by:

My child will depart the program by:

__Parent Drop-Off

__Parent Pick Up

__Supervised Walk

__Supervised Walk

__Unsupervised Walk

__Unsupervised Walk

__Public/Private Van

__Public/Private Van

__Bus

__Program Bus/Van

__Private Transportation Provided by Parent

__Private Transportation Provided by Parent

In the space below, please note any important information regarding transportation of your child to and from the program (i.e.--indicate who will be supervising children during transport or prior to their arrival at the program, who supervises the walk from a bus stop, etc.)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

________________________________________________________________________________

I additionally authorize the following individual to take my child from the child care premises. (Please let me know at the beginning of the day when your child will be picked up by one of the authorized individuals.)

Name _____________________________ Address ________________________________________

Telephone ______________ Cell Phone ____________________

Name _____________________________ Address ________________________________________

Telephone ______________ Cell Phone ____________________

Anticipated Days/Time of Attendance

 

 

 

Day

Arrival Time

Departure Time

Day

Arrival Time

Departure Time

Monday

____________ ____________

Friday

___________

____________

Tuesday

____________ ____________

Saturday

__________

____________

Wednesday

____________ ____________

Sunday

___________

____________

Thursday

____________ ____________

 

 

 

If applicable: Name of School Child Attends: ________________________________________________

Copies of any custody agreements, court orders, restraining orders (if applicable)

Notes:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

 

Child’s Name ____________________

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Parental Signatures

Written Acknowledgement of Receipt of Parent Handbook

I acknowledge that I have received a copy of the provider’s parent handbook as well as information regarding lead poisoning prevention (may be included in the parent handbook).

_______________________________________________

______________

Parent/Guardian

Date

Parental Visit Notice

I understand that I may visit this family child care home unannounced at any time during the hours that my child is in care.

______________________________________________

_______________

Parent/Guardian

Date

Child's Physician or Health Care Professional

 

Name: ______________________________________________ Telephone: ___________________

Address: ___________________________________________

Information on allergies, special diets, chronic health conditions, special limitations, concerns including medications child is taking at home/school and possible side effects:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Medical Insurance Information (OPTIONAL)

Subscriber's Name: _________________________________ Policy #: _____________________

Type of Insurance: _________________________________

[ ] Copy of Insurance Card

SCHOOL AGE ONLY

Current School: ____________________________

School Address: _________________________

 

______________________________________

I certify that documentation of physical examination and immunizations in accordance with public school health requirements, and lead poisoning screening in accordance with public health requirements are on file at my child’s school.

Parent/Guardian initials: ________________

 

Child’s Name ______________________

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DEVELOPMENTAL HISTORY AND BACKGROUND INFORMATION

Regulations for licensed child care programs require this information to be on file to address the needs of children while in care.

CHILD'S NAME _______________________________________ DATE OF BIRTH _____________

*Note: Please provide information for Infants and Toddlers (marked *) as appropriate to the age of your child.

DEVELOPMENTAL HISTORY

Age began sitting ________ crawling ______ walking _________ talking ____________

*Does your child pull up? ________ *Crawl? ______ *Walk with support? _______

Any speech difficulties?______________________________________________________________________

Special words to describe needs ______________________________________________________________

Language spoken at home _______________________ *Any history of colic? __________________________

*Does your child use pacifier or suck thumb? _____________ *When? ________________________________

*Does your child have a fussy time? ____________________ *When? ________________________________

*How do you handle this time? ________________________________________________________________

HEALTH

Any known complications at birth? ____________________________________________________________

Serious illnesses and/or hospitalizations: _______________________________________________________

Special physical conditions, disabilities: ________________________________________________________

Allergies i.e. asthma, hay fever, insect bites, medicine, food reactions:

________________________________________________________________________________________

________________________________________________________________________________________

Regular medications: _______________________________________________________________________

EATING HABITS

Special characteristics or difficulties: ___________________________________________________________

*If infant is on a special formula, describe its preparation in detail _____________________________________

________________________________________________________________________________________

Favorite foods: ____________________________________________________________________________

Foods refused: ____________________________________________________________________________

* Is your child fed held in lap? ______________ High chair? ____________________

* Does your child eat with Spoon? _____________________ Fork? ______________ Hands? _____________

TOILET HABITS

*Are disposable or cloth diapers used? _________________

*Is there a frequent occurrence of diaper rash? ____________________________

*Do you use: baby oil ________ powder ______________ lotion ________________ Other _____________

*Are bowel movements regular? ________________ how many per day? _______________

*Is there a problem with diarrhea? _______________ Constipation? ____________________

*Has toilet training been attempted? _____________

*Please describe any particular procedure to be used for your child at the program

__________________________________________________________________________________________

What is used at home? Potty chair? _______ special child seat? _________ regular seat? _________

How does your child indicate bathroom needs (include special words): _________________________

Is your child ever reluctant to use the bathroom? ___________________________________________________

Does the child have accidents? _________________________________________________________________

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SLEEPING HABITS

*Does your child sleep in a crib? ________ Bed? ________

Does your child become tired or nap during the day (include when and how long)? _____________________

_______________________________________________________________________________________

Please Note: The American Academy of Pediatrics has determined that placing a baby on his/her back to sleep reduces the risk of Sudden Infant Death Syndrome (SIDS). SIDS is the sudden and unexplained death of a baby under one year of age. If your child does not usually sleep on his/her back, please contact your physician immediately to discuss the best sleeping position for your baby. Please also take the time to discuss your child’s sleeping position with your educator. Your educator will place your infant on his/her back unless there is a written physician’s order that specifies otherwise.

When does your child go to bed at night? ______ and get up in the morning? __________________

Describe any special characteristics or needs (stuffed animal, story, mood on walking etc) ________________

________________________________________________________________________________________

SOCIAL RELATIONSHIPS

How would you describe your child:____________________________________________________________

________________________________________________________________________________________

Previous experience with other children/child care:________________________________________________

Reaction to strangers: _______________________________ Able to play alone: _______________________

Favorite toys and activities: __________________________________________________________________

________________________________________________________________________________________

Fears (the dark, animals, etc.): _______________________________________________________________

________________________________________________________________________________________

How do you comfort your child: _______________________________________________________________

What is the method of behavior management/discipline at home: ____________________________________

________________________________________________________________________________________

What would you like your child to gain from this child care experience?________________________________

________________________________________________________________________________________

DAILY SCHEDULE: Please describe your child’s schedule on a typical day.

*For Infants, please include awakening, eating, time out of crib/bed, napping, toilet habits, fussy time, night bedtime, etc.

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Is there anything else we should know about your child?___________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Parent/Guardian Signature: __________________________________

Date: _____________________

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Permissions (for each child enrolled)

General Permission-(Basic Transport) (Parents should not sign this permission unless specific places where your child is allowed to go are listed by your educator.) By signing this form, I am allowing my child to be taken off the child care premises.

I, hereby give __________________________________ permission to take my child ________________

(educator/assistant)

off the premises of the family child care home for the following excursions: (specific places your child is

allowed to go): _______________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

using the following forms of transportation: _________________________________________________

____________________________________________________________________________________

____________________________________

______________________________________

Parent/Guardian

Signature Date

I do not want my child to be taken off the child care premises.

____________________________________

_____________________________________

Parent/Guardian

Signature Date

Permission - (Transport to Medical Facility and Receive Emergency Medical Treatment)

Medical Emergency Treatment (Department of Early Education and Care recommends checking with your local hospital about the acceptability of this statement)

I, hereby give __________________________________ permission to administer basic first aid and/or

(educator/assistant)

CPR to my child ______________________________, and/or take my child to a hospital for medical

treatment when I cannot be reached or when delay would be dangerous to my child's health.

____________________________________

_____________________________________

Parent/Guardian

Signature Date

Topical Medication/Ointments (Please list only those medications/ointments which you will allow the educator(s) to administer to your child's skin): Ex: sunscreen, insect repellent (bug spray), diapering ointment.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________

_____________________________________

Parent/Guardian Signature

Date

 

Child’s Name _________________

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Emergency Card Information

REMINDER : This emergency card information is for the educator’s first aid kit. The educator(s) must take first aid materials when leaving the child care premises.

Child's Name:____________________________ Date of Birth:__________________________________

Child's Home Address:_________________________________________________________________

_________________________________________ Phone: ____________________________________

Instructions to Reach Parent or Guardian

1.__________________________________________________________________________________

(Name, Address, Home and Cell Phone #)

2.__________________________________________________________________________________

(Name, Address, Home and Cell Phone #)

Contact Information for Physician or Health Care Professional

1._________________________________________________________________________________

(Physician’s Name, Address, Phone #)

Emergency Contact Person(s)

1._________________________________________________________________________________

(Name, Address, Home and Cell Phone #)

2._________________________________________________________________________________

(Name, Address, Home and Cell Phone #)

Emergency Medical Treatment

I hereby give ____________________________________________________________ permission to

(Name of educator/assistant)

administer basic first aid and/or CPR to my child _____________________________________________

(Name)

and/or take my child _______________________________________, to a hospital for medical treatment

(Name)

when I cannot be reached or when delay would be dangerous to my child's health.

_______________________________________

______________________________________

Parent/Guardian

Date

Medical Insurance Information (Optional)

 

Subscriber's Name:____________________________________________________________________

Type of Insurance:_____________________________________________________________________

Policy Number:_______________________________________________________________________

[ ] Copy of insurance card

Other pertinent medical information:_______________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

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Dear Physician: __________________________________________________________________

(Child's Name)

is enrolled in a family child care home which is licensed by the Department of Early Education and Care. The Department of Early Education and Care’s regulations require at the time of admission a written statement from a physician as evidence of each child's annual physical examination, immunizations and lead screening in accordance with Department of Public Health's recommended schedules. A prompt response is appreciated.

Evidence of a physical exam is valid for one (1) year from the date the child was examined and must be renewed annually thereafter.

IDENTIFICATION

Name of Child: ______________________________________ Date of Birth: _____________________

Address: ________________________________________________ Phone # ____________________

Name of Parents: _____________________________________________________________________

Address: ____________________________________________________________________________

Date of Examination of Child: ___________________________________________________________

What is your opinion concerning the child's general health and appearance:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Has this child been screened for lead poisoning?

Yes ________ No _________

(*At least one (1) time between ages 9-12 months; Annually-Ages 2 & 3; at Age 4 if High Risk for Lead Poisoning)

If Yes, date screened: _______________

Does this child have any disabilities or chronic medical problems (allergies, limited vision, etc.) which require special consideration or care by the child care educator? If so, please detail below:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Physician's Signature: _______________________________________Date: ______________

Comments: __________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Please return this form and the child’s immunization record to:

 

_____________________________________

 

_____________________________________

 

_____________________________________

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