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    Child Information Sheet

    Uploaded by

    Elizabeth Degen-Skilling
    This document contains information about a child enrolling in daycare, including the child's name, date of birth, parents' contact details, emergency contacts, physician information, and notes on any special provisions, concerns, or conditions for the child. It collects key identifying and emergency contact information for a child who will be attending daycare, along with relevant medical and needs information. The parents' signatures are required to acknowledge the information provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Child Information Sheet

    Uploaded by

    Elizabeth Degen-Skilling
    21 views2 pages
    This document contains information about a child enrolling in daycare, including the child's name, date of birth, parents' contact details, emergency contacts, physician information, and notes on any special provisions, concerns, or conditions for the child. It collects key identifying and emergency contact information for a child who will be attending daycare, along with relevant medical and needs information. The parents' signatures are required to acknowledge the information provided.

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    © Attribution Non-Commercial (BY-NC)

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    This document contains information about a child enrolling in daycare, including the child's name, date of birth, parents' contact details, emergency contacts, physician information, and notes on any special provisions, concerns, or conditions for the child. It collects key identifying and emergency contact information for a child who will be attending daycare, along with relevant medical and needs information. The parents' signatures are required to acknowledge the information provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views2 pages

    Child Information Sheet

    Uploaded by

    Elizabeth Degen-Skilling
    This document contains information about a child enrolling in daycare, including the child's name, date of birth, parents' contact details, emergency contacts, physician information, and notes on any special provisions, concerns, or conditions for the child. It collects key identifying and emergency contact information for a child who will be attending daycare, along with relevant medical and needs information. The parents' signatures are required to acknowledge the information provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    CHILD INFORMATION SHEET

    Child’s name:
    First Middle Last

    Name child goes by:

    Address: Phone:
    Date of birth: Age:

    Parent/guardian name:
    Address: Phone:
    Parent/guardian name:
    Address: Phone:

    Mother’s employer:
    Address: Phone:
    Father’s employer:
    Address: Phone:

    Emergency contact person


    1) Name:
    Relationship:
    Address: Phone:

    2) Name:
    Relationship:
    Address: Phone:

    Additional persons who may pick up the child:


    Name:
    Relationship:
    Name:
    Relationship:

    SELF-COUNSEL PRESS/DAYCARE
    Physician’s name:
    Address: Phone:

    Comments: (things we should know about your child — disabilities, hobbies, special
    interests, shyness, etc.)

    Child will need extra provisions such as: (transportation to and from school or extra curricular
    activities, help with homework, etc.)

    Other concerns:

    Proposed date of admission:

    Date: Parent signature:

    Parent signature:

    ***********************************************************************************
    PLEASE DO NOT FILL IN THIS SECTION

    Date of admission to care:

    Date of termination of care:

    Child’s progress:

    SELF-COUNSEL PRESS/DAYCARE

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