Child Update Form BCDC 2 2025
Child's Full Name
*
First Name
Last Name
Preferred Name
If different from above
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Grade
Only if in public school
Parent/Guardian 1 Information
Full Name
*
Relationship to Child
*
Mother
Father
Guardian
Grandma
Grandpa
Aunt
Uncle
Sibling (over 18)
Family Friend
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Work Phone Number
Place of Employment
*
Cell Phone Number
*
Email
*
example@example.com
Parent/Guardian 2 Information
Full Name
*
First Name
Last Name
Relationship to Child
*
Mother
Father
Guardian
Grandma
Grandpa
Aunt
Uncle
Sibling (over 18)
Family Friend
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
*
Work Phone Number
*
Place of Employment
*
Cell Phone Number
*
Email
*
example@example.com
Back
Next
Authorized Child Pickup and Emergency Contacts
Please list those individuals other than the parents/guardians listed above that are authorized to pickup your child. The persons listed below are also used as emergency contacts in the event that you cannot be reached. At least one individual listed must have an address that is not the same as the parent/guardian listed above and all listed individuals must be at least 18 years of age.
Contact 1
*
First Name
Last Name
Relationship to child
*
Guardian
Grandma
Grandpa
Aunt
Uncle
Sibling (over 18)
Family Friend
Other
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact 2
*
First Name
Last Name
Relationship to child
*
Guardian
Grandma
Grandpa
Aunt
Uncle
Sibling (over 18)
Family Friend
Other
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact 3
*
First Name
Last Name
Relationship to child
*
Guardian
Grandma
Grandpa
Aunt
Uncle
Sibling (over 18)
Family Friend
Other
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is there anyone specific that should NEVER pickup your child?
*
Yes
No
Names/Relationships to child
*
Reason
*
Authorization for Emergency Medical Attention
In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:
Name of Physician
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Preferred Hospital (name, address, phone)
*
Cook Children's Medical Center, 801 7th Ave, Fort Worth, TX 76104, (682) 885-4000
Texas Health Huguley Hospital Fort Worth South. 11801 South Freeway, Burleson, TX 76028 , 817-293-9110.
Texas Health Fort Worth, 1301 Pennsylvania Ave, Fort Worth, TX 76104, (817) 250-2000
Baylor Medical Center, 1400 8th Ave, Fort Worth, TX 76104, (817) 926-2544
John Peter Smith Hospital, 1500 S Main St, Fort Worth, TX 76104, (817) 702-3431
Other
Second Choice Hospital (name, address, phone)
*
Cook Children's Medical Center, 801 7th Ave, Fort Worth, TX 76104, (682) 885-4000
Texas Health Huguley Hospital Fort Worth South. 11801 South Freeway, Burleson, TX 76028 , 817-293-9110.
Texas Health Fort Worth, 1301 Pennsylvania Ave, Fort Worth, TX 76104, (817) 250-2000
Baylor Medical Center, 1400 8th Ave, Fort Worth, TX 76104, (817) 926-2544
John Peter Smith Hospital, 1500 S Main St, Fort Worth, TX 76104, (817) 702-3431
Other
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Does your child have any special care needs?
*
Yes
No
Please share details of the special care your child requires.
*
Any limitations or restrictions on the child’s activities; special care the child requires, including: Any reasonable accommodations or modifications; any adaptive equipment provided for the child, including instructions for how to use the equipment; and symptoms or indications of potential complications related to a physical, cognitive, or mental condition that may warrant prevention or intervention while the child is in care.
Is your child on any continuous, long-term use medications?
*
Yes
No
Please list all continuous, long-term medications and dosage.
*
List any known allergies.
*
Type NONE if your child does not have any known allergies.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Back
Next
Permissions
I hereby give consent for my child to be transported and supervised by the operations employees for the items checked below.
*
Emergency Care (required to be in care)
Field Trips
To and From School
I hereby give consent for my child to participate in field trips:
*
In house field trips at the center
Field Trips away from the center (transportation permission required above)
I hereby give consent for my child to participate in the following water activities:
*
Water Table Play
Sprinkler Play
Splashing/Wading Pools
Swimming Pool
Is your child able to swim without assistance?
*
Yes
No
From time to time our facility may photograph your child for portraits, crafts, posting a project in our classrooms, monthly newsletter I hereby give/ do not give consent for the facility to take photos of my child for these purposes.
*
Please Select
Yes
No
From time to time our facility may photograph your child on our website and social media pages, newspaper articles, etc. I hereby give/ do not give consent for the facility to take photographs of my child for these purposes
*
Please Select
Yes
No
I hereby give/do not give consent for broad spectrum sunscreen to be applied to my child in accordance to the Parent Handbook. (Parent's must supply the sunscreen)
*
Give consent
Do not give consent
I hereby give/do not give consent for bug spray to be applied to my child in accordance to the Parent Handbook. (Parent's must supply the bug spray)
*
Give consent
Do not give consent
Signature
*
Submit
Should be Empty: