Statement of health form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information, including your name, phone number, address, and social security number. Ensure all details are accurate for proper identification.
3. Indicate your relationship to the child care facility by selecting one of the options: Day Care Provider, Care Giver, Spouse, or Other Adult Living in the Home.
4. Carefully read each health-related question. For each question regarding chronic conditions or mental health issues, mark 'Yes' or 'No' as applicable. If you answer 'Yes', provide detailed explanations in the space provided or on additional paper.
5. In the Additional Comments section, feel free to add any relevant information that may assist in your application process.
6. Finally, review all entered information for accuracy before signing and dating the form at the bottom. This confirms that you understand and agree with the statements made.

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