Form 2935-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the Admission Information section. Enter the Operation Name, Director’s Name, Child’s Full Name, Date of Birth, Home Telephone Number, and Home Address.
3. Next, provide the Date of Admission and Date of Withdrawal. Fill in the Parent’s or Guardian’s Name and their Address if different from the child’s address.
4. List telephone numbers for parents/guardians where they can be reached while the child is in care. Include Mother’s, Father’s, and Guardian’s Telephone Numbers along with a Cell Phone Number.
5. Complete the emergency contact information by providing a name, address, phone number, and relationship of a person to call if parents/guardians cannot be reached.
6. Indicate transportation preferences and consent for field trips and water activities by checking the appropriate boxes.
7. Acknowledge receipt of operational policies and specify meal preferences for your child during care.
8. Fill out details regarding your child's school attendance and immunization records as required.
9. Finally, sign and date the form at the bottom to authorize emergency medical attention if necessary.

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