LITTLE TOT'S LEARNING DAYCARE, II 1028 Schuman Place Baldwin, NY 11510

LITTLE TOT'S LEARNING DAYCARE, II 1028 Schuman Place Baldwin, NY 11510

GENERAL PERMISSION FORM
Date:

MonthDayYear
Date
Parent/Legal Guardian Name:

First NameLast Name
Phone Number:
Email:
example@example.com
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to the Minor:
Child's Name:

First NameLast Name
Gender:

MaleFemale
Date of Birth:

MonthDayYear
Date
Field Trip & Off-Premises Permission:

I, the Parent/Guardian hereby give Little Tot's Learning daycare, II permission to take my child(ren) off the daycare premises and on excursions that will take place during regular childcare hours. I understand that I may or may not be notified of any such trips beforehand, that trips will be supervised and that all precautions will be made for the safety and well-being of all children.

I, the Parent/Guardian, also understands that Little Tot's Learning Daycare, II will not be liable for any incidents, accidents, or injuries that may occur on or off premises or during daycare hours.
I give my child permission to participate in the following: (Check all that applies)*

Ride in the provider’s van and/or personal vehicle.Receive an occasional treat (e.g., McDonald’s, pizza, ice cream, candy, cake).Go on neighborhood walks under supervision.Participate in water play at the park or on daycare premises.Have their photograph taken for newsletters, social media, or daycare use.If school-aged, be observed every 15 minutes while in care.Ride a bike with appropriate safety measures.Ride in a stroller or wagon during outdoor activities.
I give my child permission to participate in the following:*

Neighborhood parksNeighborhood LibraryTrips to the doctorGrocery shoppingNature WalksUnannounced field tripsRun errands
Does the child have any allergies?

YesNo
Does the child have any medical conditions that you would like to declare?
Any special instructions?
Are there any other activities in which your child should not participate?
Name

First NameLast Name
Parent's Signature

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Name

First NameLast Name
Provider's Signature

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