Form 2685 - Children'S Attendance Record
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1
2STATE OF NEW HAMPSHIRE
Form 2685
Department of Health and Human Services
February 2017
Division for Children, Youth and Families
CHILDREN’S ATTENDANCE RECORD
(ORIGINAL PARENT/GUARDIAN SIGNATURE REQUIRED)
CHILD CARE PROGRAM: _____________________________________________________________________________
WEEK BEGIN AND END DATE: ____/____/____
____/____/____
TO
CLASSROOM/GROUP NAME:
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
REQUIRED
/
FULL NAME OF CHILD
ARRIVE
DEPART
ARRIVE
DEPART
ARRIVE
DEPART
ARRIVE
DEPART
ARRIVE
DEPART
ARRIVE
DEPART
ARRIVE
DEPART
PARENT
GUARDIAN SIGNATURE
1.
D.O.B
2.
D.O.B
3.
D.O.B
4.
D.O.B
5.
D.O.B
6.
D.O.B
7.
D.O.B
CHILD ATTENDANCE RECORDS MUST AT ALL TIMES, REFLECT THE ACTUAL ARRIVAL AND DEPARTURE TIME*
.
SEE NOTE ON BACK
.
I CERTIFY THAT THE INFORMATION ON THIS ATTENDANCE RECORD IS TRUE AND ACCURATE
C
C
P
’
S
:
R
:
HILD
ARE
ROVIDER
S
IGNATURE
ESOURCE IDENTIFICATION NUMBER
PD 17-17
February 2017
1 |
P a g e
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