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Enrollement Form Day Care 1

This document is a child care registration form for Milestones Child Care. It collects information such as the child's name, date of birth, parent/guardian contact information, emergency contacts, medical information including doctors and allergies, and consent for emergency medical treatment. The form also requests additional documents to be submitted such as passport photos of the child and parents, vaccination records, and copy of identification.

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37 views

Enrollement Form Day Care 1

This document is a child care registration form for Milestones Child Care. It collects information such as the child's name, date of birth, parent/guardian contact information, emergency contacts, medical information including doctors and allergies, and consent for emergency medical treatment. The form also requests additional documents to be submitted such as passport photos of the child and parents, vaccination records, and copy of identification.

Uploaded by

fatimahjawwad9697
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MILESTONES CHILD CARE REGISTRATION FORM

Child’s name: Nickname: Birth date:

Child’s parent/guardian name: Home phone #: Cell phone #: Alternative #:

Home Address:

Address where you can be reached when child is in care:

Child’s parent/guardian name: Home phone #: Cell phone #: Alternative #:

Home Address:

Address where you can be reached when child is in care:

Other than you who has permission to pick up your child?


Name Address Telephone number
Name: Home:
Relationship: Cell:
Alternative:
In case of an emergency, I give permission for any of the following individuals to be
contacted and my child may be released to any of them.

Parent/guardian signature: ____________________________

Name Address Telephone number


Name: Home:
Relationship: Cell:
Alternative:
Name: Home:
Relationship: Cell:
Alternative:
Who does not have permission to pick your child? If applicable (a copy of supporting court
document must be on file)
Name: Reason:

Child Health Information


Child’s Pediatrician: Contact number:
Landline:
Cell:
Address:

Special health problem? Yes or No? If Yes, Allergies, including drug reactions
specify. Yes or No? If Yes, specify

Consent to medical care and treatment of minor children


I give permission that my child ________________________________, may be given
first aid/emergency treatment by a child care provider/qualified staff at Milestones.

Parent/guardian signature: Date: Parent/guardian signature: Date:

When I cannot be contacted, I authorize and consent to medical/hospital care/treatment


to be performed by a licensed physician/health care provider, hospital or aid car assistant
when deemed necessary or advisable by a physician to safeguard my child’s health.
I also give my permission for my child to be transported by ambulance or aid car to a
hospital for treatment.

Parent/guardian signature: Date: Parent/guardian signature: Date:

Note: Please provide the following when submitting this form


 4 passport sized pictures of your child.
 Allergy list (in case of children who have allergies)
 Vaccination card
 2 passport sized pictures of both parents/guardian
 Copy of your NIC or Passport

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