Get Child Enrollment And Emergency Medical Care Form - Ct

Filling out the Child Enrollment And Emergency Medical Care Form - Ct online is a crucial step in ensuring your child's safety and well-being while in care. This guide provides clear instructions to help you accurately complete the form with confidence.

Follow the steps to fill out the form online:

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering the date of application, enrollment date, and last day of enrollment in the designated fields.
3. Fill in your child's name and date of birth accurately, followed by their address, city, and zip code.
4. Provide the mother's details, including name, address, city, zip code, email address, home phone number, and cell phone number.
5. Enter the mother's employer information, including the name, work number, and employer's address.
6. Repeat the same process for the father’s information, ensuring all fields are filled out accurately.
7. Indicate the weekly care schedule by specifying the child’s hours in care for each day of the week.
8. List persons permitted to remove the child from care, providing their name, phone number, and relationship to your child.
9. Identify adults who may be contacted in an emergency if you are unreachable, providing their name, phone number, and relationship.
10. Record any known allergies, the date of the last tetanus shot, insurance carrier information, and the child’s physician and dentist details.
11. Give consent for the daycare provider to contact the named physician or dentist in case of a medical emergency, and indicate a facility for medical attention if required.
12. Specify if your child has a familial relationship with the childcare provider, detailing the nature of that relationship if applicable.
13. Review the form for completeness, then sign and date it twice, as required, for both parents or guardians.
14. Finally, ensure to save changes, download, print, or share the completed form as necessary.

Complete your child's enrollment and emergency medical care form online today for timely and proper care.