Rising Starz Medical Forms

Rising Starz Medical Forms
Child's Name
Date of Birth

MonthDayYear
Date
You must provide a doctor that your child sees on a regular basis.
Child's regular physician*
Address of physcian
Phone Number to doctors office*
Fax Number
City, State Zip
If your child does not attend a public pre-kindergarten that is aways from the child care center, we must have the doctors statement of health on file before enrollment can begin.
My child has been examined within the past year by health care professional and is able to participate in the childcare / daycare program, within 12 months admission, will obtain a health care professional's signed statement and will submit it to the child care operation*

Clear
Medical Release By signing below I authorize the doctor's office listed above to release information regarding my child to Rising Starz Child Care Center for enrollment purposes located at 1200 E. Jackson RD BLDG 1, Carrollton, TX 75005 Phone number 972-466-3800 FAX 972-695-6270. This Release is good for 90 days from the date signed.

Authorizations of Emergency or Medical Treatment if for any reason I can not be reached to make medical arrangements for emergency care for my child listed above for illness or injury, - give consent for a Rising Starz Child Care Center Staff member to transport my child to the doctors office listed above, or to Legent Health located at 1401 E. Trinity Mills Carrollton, TX 75006 817-421-1066 or the closest emergency room. I give consent for the facility listed to secure any and all emergency medical care for my child. Rising Starz Child Care Center gives no guartees for treatment or examination.
Responsible Party Signature*

Clear
Date

MonthDayYear
Date
Rising Starz Child Care Center Illness Notices
Parent or Guardians please read and mark that you have read the following illness policy.

Illness Notices / Policy

	I agree
1. I understand that if my child is to attend Rising Starz Child Care Center for the day, my child must meet DFPS 746.3601 Licensing Law -If your child is ill or need to be excluded from our daily activity plans they are considered too ill to be in care for the day. Preventing the child from participating comfortably in the child care centers daily activity plan is prohibited. We are not licensed as a wellness center.
2. Throughout the day if my child becomes ill they will be separated from the rest of the students in the school. I understand that I must pick up my child from the facility if they become ill with in 30 minutes.
While we understand that many illness symptoms can also be related to allergies or non threating common conditions. We must proceed with an abundance of caution with group care. Your child will need to be symptom free without medication for 48 hours before returning to care the child care facility.
3. I Understand that some illness may require a longer exclusion time than others. I understand that the child care center will inform me of the exclusion time or I can all at any time to ask 972-466-3800
4. I understand that my child may still be excluded from care for the time period that RSCCC has predetermined to be in the best interested of the class, even if the doctors note allows for the child to return.
5. I will immediately notify Rising Starz Child Care Center, when my develops a ill or will be absent due to illness.
6. I understand that while present in the facility each day my child be in contact with children, families, and employees. I understand that no list of restrictions, guidelines, or practices will remove 100% of the risk of illness. Many viruses can be transmitted from person to person before someone shows signs of being ill. I understand that I play a crucial role in keeping everyone in the facility safe and reducing the risk of exposure by following the practices outlined herin.

Parent Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

Rising Starz Medical Forms

Rising Starz Child Care Center Illness Notices

Parent or Guardians please read and mark that you have read the following illness policy.