PERMISSION FOR PHOTOGRAPHY. Photographs will occasionally be taken of our children to display in the rooms, hallways, bulletin boards or to be used for publication in our local newspapers or the Coldwater Community School’s webpage. I authorize the staff at Kids Club Childcare Center to photograph my child/children to be used for publication in the local newspapers or Coldwater Community School’s webpage. Please DO NOT photograph my child for any reason. I am aware that this permission slip will be valid for as long as my child is enrolled in this program or until I have submitted a written request to nullify all of the terms of this permission slip. Parent/Guardian Signature: PERMISSION FOR FIELD TRIP TO PARK/OR WALKING OUTINGS Kids Club Childcare Center has my permission to take my child on short outings/walks to the park or surrounding area as part of our childcare program curriculum. Parent/Guardian Signature: CHILD INFORMATION RECORD State of Michigan - Department of Licensing and Regulatory Affairs - Child Care Licensing Instructions: Unless otherwise indicated, all requested information must be provided. If the information is not known or does not apply, “unknown” or “none” is the required response. A blank field, a line through a field or “N/A” are not acceptable responses. For Date of Admission Provider Use Only: Date of Discharge Name of Child (Last, First, Middle Initial) Child’s Date of Birth / Address (Number and Street, Building/Apartment Number) City State Zip Code Parent/Legal Guardian’s Name Home Phone ( ) Parent/Legal Guardian’s Name (Optional) Home Phone ( ) Home Address (if not child’s address) Cell Phone ( ) Home Address (if not child’s address) Cell Phone ( ) City State Zip Code City State Zip Code Email Address (optional) Email Address Employer Name Work Phone ( ) Employer Name Work Phone ( ) Name of Child’s Physician or Health Clinic Physician’s or Health Clinic’s Phone Number ( ) Hospital Preferred for Emergency Treatment (optional) Allergies, Special Needs and Special Instructions (Attach additional sheets, if necessary.) BCAL-3731 (Rev. 6-17) Previous editions 4-16, 6-15 and 7-12 may be used until September 30, 2018. See Reverse Side Emergency Contact & Release of Child: List all individuals,including parents/legal guardians, in order of preference, to be contacted in an emergency. If possible, include at least one person other than the parents/legal guardians to be contacted in an emergency and to whom the child can be released. The second phone number col...
PERMISSION FOR PHOTOGRAPHY. Photographs will occasionally be taken of our children to display in the rooms, hallways, bulletin boards or to be used for publication in our local newspapers or the Coldwater Community School’s webpage. I authorize the staff at Kids Club Childcare Center to photograph my child/children to be used for publication in the local newspapers or Coldwater Community School’s webpage. Please DO NOT photograph my child for any reason. I am aware that this permission slip will be valid for as long as my child is enrolled in this program or until I have submitted a written request to nullify all of the terms of this permission slip. Parent/Guardian Signature: PERMISSION FOR FIELD TRIP TO PARK/OR WALKING OUTINGS Kids Club Childcare Center has my permission to take my child on short outings/walks to the park or surrounding area as part of our childcare program curriculum. Parent/Guardian Signature: CHILD INFORMATION RECORD State of Michigan - Department of Licensing and Regulatory Affairs - Child Care Licensing Instructions: Unless otherwise indicated, all requested information must be provided. If the information is not known or does not apply,
