Family Child Care Enrollment Packet Face Sheet Page 2

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TRANSPORTATION PLAN / AUTHORIZED PICK- UP
My child will arrive to the program by:
My child will depart the program by:
__Parent Drop-Off
__Parent Pick Up
__Supervised Walk
__Supervised Walk
__Unsupervised Walk
__Unsupervised Walk
__Public/Private Van
__Public/Private Van
__Bus
__Program Bus/Van
__Private Transportation Provided by Parent
__Private Transportation Provided by Parent
In the space below, please note any important information regarding transportation of your child to and
from the program (i.e.--indicate who will be supervising children during transport or prior to their arrival at
the program, who supervises the walk from a bus stop, etc.)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
________________________________________________________________________________
I additionally authorize the following individual to take my child from the child care premises. (Please let
me know at the beginning of the day when your child will be picked up by one of the authorized
individuals.)
Name _____________________________ Address ________________________________________
Telephone ______________ Cell Phone ____________________
Name _____________________________ Address ________________________________________
Telephone ______________ Cell Phone ____________________
Anticipated Days/Time of Attendance
Day
Arrival Time
Departure Time
Day
Arrival Time
Departure Time
Monday
____________ ____________
Friday
___________ ____________
Tuesday
____________ ____________
Saturday
__________
____________
Wednesday
____________ ____________
Sunday
___________ ____________
Thursday
____________ ____________
If applicable: Name of School Child Attends: ________________________________________________
□
Copies of any custody agreements, court orders, restraining orders (if applicable)
Notes:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Child’s Name ____________________
P a g e
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FCCEnrollmentPacket20110406

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