Your child will only be released to an authorized
person listed on this form (parent/guardian and/or emergency contact).
In case of an emergency or an unforeseen circumstance, please indicate
the name, address and phone number of any other person/s who you authorize
to pickup your child on your behalf.
A parent/guardian's verbal authorization for pickup
must be received before your child will be released to anyone not listed
here. If not received, and we cannot notify you by phone, the child
will not be released.
Medical Ins. #
Child's Personal ID#:
Please indicate likes/dislikes, potty training, special interests, etc.
The Health Unit now requires that we have a photocopy
of your child's recent immunization record in our files. Please include
a photocopy with this registration form. If you do not have the records,
a copy can be obtained from your local health unit.
It is the policy of Child's Play Family Daycare
to notify a parent when a child is ill or needs medical attention.
Occasionally, we cannot contact a parent and we need to get immediate help
for the child. Our procedure is to take the child to the nearest
Please sign below so that we can take appropriate
action on behalf of your child.
I HEREBY GIVE MY/OUR CONSENT FOR MY/OUR CHILD
WHEN ILL/INJURED, TO BE TAKEN TO THE NEAREST
EMERGENCY CENTER BY THE STAFF OF CHILD'S PLAY FAMILY DAYCARE WHEN I/WE
CANNOT BE CONTACTED. I CONSENT TO AN AMBULANCE BEING CALLED TO TRANSPORT
THE CHILD, IF NECESSARY. I FURTHER AGREE TO PAY ALL COSTS INCURRED