Family Child Care Enrollment Packet Face Sheet Page 6
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8Permissions
(for each child enrolled)
General Permission-(Basic Transport)
(Parents should not sign this permission unless
specific places where your child is allowed to go are listed by your educator.) By signing this form, I am
allowing my child to be taken off the child care premises.
I, hereby give __________________________________ permission to take my child ________________
(educator/assistant)
off the premises of the family child care home for the following excursions: (specific places your child is
allowed to go): _______________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
using the following forms of transportation: _________________________________________________
____________________________________________________________________________________
____________________________________
______________________________________
Parent/Guardian
Signature Date
I do not want my child to be taken off the child care premises.
____________________________________
_____________________________________
Parent/Guardian
Signature Date
Permission - (Transport to Medical Facility and Receive Emergency
Medical Treatment)
Medical Emergency Treatment (Department of Early Education and Care recommends checking with
your local hospital about the acceptability of this statement)
I, hereby give __________________________________ permission to administer basic first aid and/or
(educator/assistant)
CPR to my child ______________________________, and/or take my child to a hospital for medical
treatment when I cannot be reached or when delay would be dangerous to my child's health.
____________________________________
_____________________________________
Parent/Guardian
Signature Date
Topical Medication/Ointments (Please list only those medications/ointments which you will allow the
educator(s) to administer to your child's skin): Ex: sunscreen, insect repellent (bug spray), diapering
ointment.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________
_____________________________________
Parent/Guardian Signature
Date
Child’s Name _________________
P a g e
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FCCEnrollmentPacket20110406
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