Consent for Emergency Medical Treatment
Child's Name
*
Child's Date of Birth
*
-
Month
-
Day
Year
Date
By signing this, I give permission to Rebecca Sullivan, or Little & Loved Daycare staff to transport my child to the Bronson Hospital Emergency room if you child is in need of emergency medical treatment. If Rebecca Sullivan, or Daycare staff, are unable to transport my child to Bronson Hospital, I give permission to have my child transported via ambulance services. I understand I am responsible for any fees incurred for emergency services.
Parent Signature
*
Parent/Guardian Name
*
Parent's Name
Date
*
/
Month
/
Day
Year
Date
Parent Handbook Receipt Confirmation
I am contracted for the following hours:
Monday
Tuesday
Wednesday
Thursday
Friday
I am contracted at the following rate: / day
Parent name
Parent Signature
*
Child's Name
Date of birth
/
Month
/
Day
Year
Date
Date
/
Month
/
Day
Year
Date
Photo Consent
Parent's Name
Child's Name
Child Date of Birth
-
Month
-
Day
Year
Date
I give permission to Rebecca Sullivan, or Little & Loved Daycare staff, to take pictures of my child for:
*
Updates through text messaging
Posting to social media (Facebook and Instagram) and/or professional website for Little & Loved Daycare.
I do not give consent for my child's photo to be taken.
Parent Signature
*
Parent Name
Date
/
Month
/
Day
Year
Date
Parent/Guardian email address
*
example@example.com
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Should be Empty: