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.
Question | Answer |
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Form Name | Printable Daycare Form |
Form Length | 8 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 2 min |
Other names | drop in forms for daycare, daycare blank forms, daycare forms, printable daycare enrollment forms |
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*P H O T O OF C H I L D |
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FAMILY CHILD CARE |
(*Optional) |
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Children’s Records must |
P L U S |
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five (5) years after a child |
ENROLLMENT PACKET |
P H Y S I C A L |
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be maintained for at least |
F A C E S H E E T |
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has left the program |
D E S C R I P T I O N |
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Eye Color _______ |
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Please fill out these forms completely. If a question does not apply |
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Hair Color ______ Sex_____ |
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to your child, write N/A (not applicable). The forms must be in the |
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Height _____ Weight _______ |
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educator’s possession on or before the first day your child begins |
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Other:____________________ |
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care. Please notify your educator if any of the information changes. |
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_________________________ |
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General Information |
_________________________ |
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Date of Admission ________________ Age at Admission: ______ |
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Date of Discharge ______________
Reason for Discharge: _________________________________________________________________
____________________________________________________________________________________
Child's full name ______________________________Date of Birth ______________________________
Address:_______________________________ |
City:___________________ Zip:________________ |
Telephone Number: ______________________________ Nickname __________________ |
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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
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 __________
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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 |
__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 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 |
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Day |
Arrival Time |
Departure Time |
Day |
Arrival Time |
Departure Time |
Monday |
____________ ____________ |
Friday |
___________ |
____________ |
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Tuesday |
____________ ____________ |
Saturday |
__________ |
____________ |
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Wednesday |
____________ ____________ |
Sunday |
___________ |
____________ |
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Thursday |
____________ ____________ |
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If applicable: Name of School Child Attends: ________________________________________________
□Copies of any custody agreements, court orders, restraining orders (if applicable)
Notes:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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Child’s Name ____________________ |
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FCCEnrollmentPacket20110406 |
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 |
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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: _________________________ |
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______________________________________ |
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: ________________
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Child’s Name ______________________ |
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FCCEnrollmentPacket20110406 |
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
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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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FCCEnrollmentPacket20110406 |
Permissions (for each child enrolled)
General
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 |
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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) |
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Subscriber's Name:____________________________________________________________________
Type of Insurance:_____________________________________________________________________
Policy Number:_______________________________________________________________________
[ ] Copy of insurance card
Other pertinent medical information:_______________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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FCCEnrollmentPacket20110406 |
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
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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