Parents Registration Form

Onsite Child Care Parents Registration Form
Parent/Guardian Name*

First NameLast Name
Date/Time*

YYYY/MM/DDTime
E-mail*
example@example.com
Phone Number*
Parents/guardians must provide reliable contact phone number(s) that will be answered in case of emergency while attending event
Child's Name*

First NameLast Name
Child's age*
Child's Name 2

First NameLast Name
Child # 2 age
Child's Name 3

First NameLast Name
Child # 3 age
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permission to have cookies and water/juice:

YesNo
Medical Conditions, Allergies, or Exceptionalities (if yes please indicate):*
Time of drop off:*
Time of pick up:*
Password:*
EMERGENCY MEDICAL SERVICES/TREATMENT CONSENT

In the event of an emergency situation resulting from an accident or illness while my child is in care, if I am not immediately available or cannot be immediately contacted, I consent for my child to be given the necessary care and/or treatment provided by a licensed physician or hospital where my child has been taken to. I understand that the staff will continue to contact me to inform me of the details of the emergency and any medical expenses incurred for such treatment are my responsibility.

EMERGENCY EVACUATION

In the event of an emergency situation resulting in a building evacuation, I consent for my child to be evacuated by Network Child Care & One of a Kind Staff to the designated evacuation meeting location. Once evacuated, I will be reunited with my child safely in the evacuation meeting location.
Parent/Guardian Signature:*

Clear
Should be Empty:

Onsite Child Care Parents Registration Form