School Age Children. My Child attends the following school Name of School and Address School Ph. # CHECK ALL THAT APPLY: His / her immunization record is on file at the school and all required immunizations and/or tuberculosis test are current. Vision and Hearing screening records are also on file. My child has permission to: ride a bus and/or walk to and from school, be released to the care of his/her sibling(s) under 18 years old. Name of Sibling(s): IMMUNIZATION RECORD: I have provided the childcare operation with a copy of my child’s most current immunization record. ADMISSION REQUIREMENT: If your child does not attend pre-kindergarten or school away from the child-care operation, one of the following must be represented when your child is admitted to the child-care operation or within one week of admission. Please check only one option: 1. HEALTH-CARE PROFESSIONAL’S STATEMENT: I have examined the above named child within the past year and find that he / she is able to take part in the day care program. Health Care Professional’s Signature Date 2. A signed and dated copy of a health care professional’s statement is attached.
Appears in 5 contracts
Samples: Customer Revised Agreement, Customer Revised Agreement, Customer Revised Agreement
