Consent Forms

Consent Forms
Parent's Name

First NameLast Name
Child's Name

First NameLast Name
Consent to Field Trip

As part of Modern Education Family Childcare program, we will take the children in our care on some field trips away from home. The typical destinations of these field trips may include, but is not limited to:
- walks through the neighborhood
- walks to the local park
- walks to the local school playground
- Other _______________________________________
I agree and consent to field trip.
Consent to Use Picture/Video
I agree and consent to use picture/video.
Consent to Developmental Screening
The first 5 years of life are very important for your child because this time sets the stage for success in school and later life. During infancy and early childhood, your child will gain many experiences and learn many skills. It is important to ensure that each child’s development proceeds well during this period.

We use ASQ-3 and ASQ-SE to ensure your child's various development. Learn more about ASQ-3 and ASQ-SE here.
Please read the text below and mark the desired space to indicate whether you will participate in the screening/monitoring program.
Signature
Should be Empty:

Consent to Field Trip