HARCATUS HEAD START -Change of StatusSite:

Enter data into Child Plus as it is received. Staff Initials & Date Changes made on the appropriate forms in the Attendance Notebook and in the Bus Notebook. Complete a new section rather than a new form until a new form is needed.

Child’s Name: ______Parent Name(s): ______

Phone/Address Changes / Phone/Address Changes / Family Status
New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ □ Child New Name: (must provide documentation)
______
□ Parent New Name:
______
Parent Signature & Date:
______
Copy must be submitted to Bev Statler in FA monthly report folder. Staff initials & date submitted: ______
Staff Initials & Date Entered:______
New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ □ Child New Name: (must provide documentation)
______
□ Parent New Name:
______
Parent Signature & Date:
______
Copy must be submitted to Bev Statler in FA monthly report folder. Staff initials & date submitted: ______
Staff Initials & Date Entered:______
New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ □ Child New Name: (must provide documentation)
______
□ Parent New Name:
______
Parent Signature & Date:
______
Copy must be submitted to Bev Statler in FA monthly report folder. Staff initials & date submitted: ______
Staff Initials & Date Entered:______
New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ □ Child New Name: (must provide documentation)
______
□ Parent New Name:
______
Parent Signature & Date:
______
Copy must be submitted to Bev Statler in FA monthly report folder. Staff initials & date submitted: ______
Staff Initials & Date Entered:______
New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ New Phone: ______
New Message Phone:______
New Cell: ______
New Address: ______
______
Staff Initials & Date Entered:______/ □ Child New Name: (must provide documentation)
______
□ Parent New Name:
______
Parent Signature & Date:
______
Copy must be submitted to Bev Statler in FA monthly report folder. Staff initials & date submitted: ______
Staff Initials & Date Entered:______

HSFCP004 REV. 6/17