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					                      Form #1
 Ongoing Over the Counter (OTC) Medications Consent
                       Form
Child’s Name
        ___________________________________Date___________________

I/We hereby give permission to Julie Hayden (Daycare Provider) to apply or give one
or more of the following OTC medications or external preparations, in accordance
with the directions for use on the container: * Denotes items to be supplied by
Parents if use is requested.
                      Tylenol*
                      Baby Wipes*
                      Band-Aids
                      Neosporin
                      Bactine or similar first-aid spray
                      Sunscreen*
                      Insect Repellent*
                      Non-Prescription Ointment (such as A&D , Desitin, Vaseline)*
                      Powder*
                      Baby Lotion*
                 *Other (Please specify)

Specify frequency and duration of use


Special instructions for use:


Note: If the instructions for administering the medication, cream, etc. are not printed
on the container (such as with Tylenol for Children under 2), then I need written
instructions from the Child’s doctor indicating the appropriate dosage to be given.

I/We hereby request the Daycare Provider administer one or more of the above OTC
medications or external preparations in accordance with the directions on the
container as needed. This consent is valid from and continuously unless otherwise
stated. I/We may withdraw this request at any time in writing. I/We release the
Daycare Provider from any liability for administering these preparations.

Parent/Guardian Signature
Print Name __________________________________________                 Date


Parent/Guardian Signature
Print Name __________________________________________                 Date


Provider Signature _____________________________________              Date
                              Form #4
                        Local Outing Consent
I/We authorize Julie Hayden (Daycare Provider) or any of her assistants to take
my/our Child (name of Child)________________________________on walking
trips. I/We understand all such trips are under adult supervision and that health and
safety precautions are taken.


Parent/Guardian Signature
Print Name __________________________________________               Date


Parent/Guardian Signature
Print Name __________________________________________               Date


Provider Signature _____________________________________             Date
                    Julie Hayden
                             Form #5
                    Child Pickup Authorization
         (Adapted from State of CA Department of Social Services Form LIC 700)

The following individuals are authorized to pick up my/our Child from Daycare on a
regular basis.
(Name of Child) ______________________________________:

Name ____________________ Address _______________________________
Relationship to Child ________________ Phone _________________________
Description:__________________________________________________________


Name ____________________ Address _______________________________
Relationship to Child ________________ Phone _________________________
Description:__________________________________________________________


Additional persons who may pick up my/our Child on a less frequent basis:


Name ____________________ Address _______________________________
Relationship to Child ________________ Phone _________________________
Description:__________________________________________________________


Name ____________________ Address _______________________________
Relationship to Child ________________ Phone _________________________
Description:__________________________________________________________




                                                                         Page 1 of 2
                          Child Pick-up Authorization (Cont.)


Any person(s) NOT authorized to pick up my/our Child:

Name ____________________ Address _______________________________
Relationship to Child ________________ Phone _________________________
Description:__________________________________________________________


Name ____________________ Address _______________________________
Relationship to Child ________________ Phone _________________________
Description:__________________________________________________________


Note: Any person unfamiliar to Provider will be required to show proof of identification and
state the code word. Under NO circumstances will the Child be released to anyone other
than those listed above without WRITTEN permission from the Parent.

Parent/Guardian Signature
Print Name __________________________________________                      Date




Parent/Guardian Signature
Print Name __________________________________________                      Date



Provider Signature _____________________________________                    Date
                    Julie Hayden




                                                                               Page 2 of 2
                            Form #8
                   Permission for Outdoor Play
I/We give permission for my/our Child (name of Child) _____________________
to play outdoors with the other Children. I am aware that the Provider or an assistant
must be within sight or hearing of the Children at all times.



Parent/Guardian Signature ______________________________
Print Name __________________________________________                Date ________


Parent/Guardian Signature ______________________________
Print Name __________________________________________                Date ________




Provider Signature _____________________________________             Date
                             Form #9
                     Permission for Water Play

I/We give my permission for my/our Child (name of Child) _____________________
to participate in water play activities at Daycare. I understand that the Children will
be supervised at all times.



Parent/Guardian Signature ______________________________
Print Name __________________________________________                 Date ________


Parent/Guardian Signature ______________________________
Print Name __________________________________________                Date ________




Provider Signature _____________________________________              Date ________
                    Julie Hayden
             Medical History and Health Record
  (See attached State of California, Department of Social Services Form LIC 702)

                      This form MUST be renewed annually.


I/We have read and consent to Form LIC 702



Parent/Guardian Signature ______________________________
Print Name __________________________________________            Date ________


Parent/Guardian Signature ______________________________
Print Name __________________________________________             Date ________




Provider Signature _____________________________________          Date ________
                    Julie Hayden
             Quick-Reference Family Information
                         (please print all information)
Child:
Name_____________________________________________ DOB__________________

Address where Child resides: __________________________________________________
                             Street Address             City        State   Zip
Phone where Child resides:___________________

Preschool/School Child attends:_________________________ Phone_________________

Child’s
siblings________________________________________________________________

Does Child have Pets at home?_______ Fingerprint record?_______

Child’s Doctor:______________________________________ Phone_________________

Description of Child:_________________________________________________________

Additional info on Child:_______________________________________________________

Father/Guardian:
Name____________________________________________

Address:__________________________________________________________________
          Street Address                       City          State   Zip
Home Phone:_______________ Business #:______________ Cell #__________________

Employer________________________________Address___________________________

Medical Insurance Plan:_______________________________ Policy #________________

Mother/Guardian:
Name____________________________________

Address:_________________________________________________________________
          Street Address                        City          State   Zip
Home Phone:________________ Business #:______________ Cell #__________________

Employer_______________________________Address___________________________

Medical Insurance Plan:_______________________________ Policy #_______________


Emergency Contact #1________________________________ Phone________________
                          Name / Relationship

Emergency Contact #2________________________________ Phone________________
                          Name / Relationship

				
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