Family Child Care Sample Forms Packet Page 5
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12Indirect Supervision Form
Permission for children Seven (7) years of age or older to use approved space without direct
supervision
The family child care regulations allow children seven (7) years of age or older to participate in
activities without direct supervision in the approved space indoor/outdoor space of the family
child care home. In order to do this, both the parent and the educator must give permission.
Educator guidance must be available when requested or needed. The educator must also
regularly monitor the activity of each child.
My child, ___________________, who is _______ years of age, has my permission to go to
the following approved indoor/outdoor space (if indoor, please list floor level and room):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
With the following limitations and stipulations:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Parent/Guardian Signature: ______________________________________ Date:_________________
Permission for children Nine (9) years of age or older to leave the family child care premises
without direct supervision
The family child care regulations allow children nine (9) years of age or older to leave the family child care
premises for a specific activity (such as riding a bike, team sports), so long as both the parent and the
educator give such permission. The educator must obtain written parent consent for any child to leave the
family child care premises.
My child ___________________ who is _______ years of age, may leave the family child care premises
for the following activities:
Activity
Time
Method of
Person
Limitations
Transportation
Responsible
Parent/Guardian Signature: ______________________________ Date: _______________________
Page 5 of 12
FCCSampleFormPacket20100203
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