Zoo Naround Preschool

Enrollment Form

Zoo’nAround Preschool

Early Adventures Academy

Parent/ Guardian #1 Information

Name: ______Home Phone: ______

Address: ______City______

State______Zip ______

Employer: ______Work Phone: ______

Cell / Other Phone: ______Social Security Number: ______

Parent/ Guardian #2 Information

Name: ______Phone: ______

Address: ______City______

State______Zip ______

Employer: ______Work Phone: ______

Cell / Other Phone: ______Social Security Number: ______

Emergency contacts may be called in the event of an emergency,People listed below are authorized to remove your child from the facility. (Your child will not be allowed to leave with any other person without written authorization from parent or guardian).

Emergency Contact #1

Relationship: ______

Name: ______Phone: ______

Address: ______

(Street) (City) (State) (Zip)

Cell / Other Phone: ______

Emergency Contact #2

Relationship: ______

Name: ______Phone: ______

Address: ______

(Street) (City) (State)

Cell / Other Phone: ______

Emergency Contact #3

Relationship: ______

Name: ______Phone: ______

Address: ______

(Street) (City) (State)

Cell / Other Phone: ______

Medical Info

Doctor’s Name: ______Phone: ______

Preferred Hospital: ______Phone: ______

Does your child have any special problems or fears? Explain: ______

Are the problems serious enough to restrict our child’s activities? Yes No

Explain: ______

Describe, if any, special care required: ______

Does your child have frequent colds? Yes No How many in the last year? ______

List any allergies staff should be aware of: ______

Is your child currently taking prescribed medication? Yes No

If yes, for what reason? Is it a chronic illness? Yes No

What is the mane of the medication? ______

What do you plan to do when your child is ill? ______

CONSENT FOR MEDICAL TREATMENT

In an emergency, Zoo’nAround Preschool has my, ______permission

(parent/ guardian name)

to call an ambulance or to take my child to any available physician or hospital at my expense. Yes No

In an emergency, my child may receive first aid: Yes No

In an emergency, Zoo’nAround Preschool has my permission to call the doctor listed above and, if necessary,I give consent to any doctor or hospital to administer medical or surgical treatment and care for mychild at my expense. Yes No

Signature(s) Today’s Date: ______

______

Parent / Guardian Signature Printed Name Relationship Date

______

Parent / Guardian Signature Printed Name Relationship Date

Zoo’n Around / Early Adventures

Child’s Name: ______Date: ______

Field Trip & Transportation Consent

I hereby give permission to Zoo’n Around Preschool/ Early Adventures Academy for my child ______for the following: (name of child)

To participate in field trips not involving transportation such as walks in the neighborhood, walks to the playground, parks and libraries.

To participate in field trips involving private transportation.

Comments or Exceptions:

______

Date :______Parent/Guardian signature:______

Photo Release

Photographs and videos are taken on occasion such as birthdays, holidays, outings, curriculum activities, and special occasions. We use these pictures/videos in our child care home for teaching, arts & crafts, albums and various other things.

Please mark the appropriate box:

□I give permission for photos to be taken□I do not give permission For photos to be take

□Pictures maybe used for media purposes such as Facebook

I understand that these photographs and/or videos will not be sold, distributed, but may be placed on internet web sites.

Date:______Parent/ Guardian signature: ______

Sunscreen Release

The state of Nevada now requires that we get permission in order to apply sun block on your child. We ask each parent to provide one bottle of sun block for the summer and we provide the rest. If your child has any allergies you are required to provide your own sun block.

Date: ______Parent/ Guardian signature: ______

Emergency Release

Child’s Name: ______

Child’s Doctor:______Phone:______

Child’s Health #______ID#______

Allergies:______

Medication:______

Medical Condition:______

It is Zoo’nAround Preschool/ Early Adventures Academy responsibility to notify a parent when a child is ill or in need of medical attention. Occasionally we are unable to contact parents, and we need to get immediate help for the child.

Our procedure is to have the child taken to the nearest emergency service by ambulance. (Ambulance fee is the parent’s responsibility).

If an ambulance is not available, the child care provider/staff will transport the child.

I hereby give permission to the child care provider/staff of these centers to make necessary transportation arrangements for my child who has become ill or injured.

______

Signature of parent/guardian Signature of parent/guardian

______

Date Date

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