List telephone numbers below where parents/guardian may be reached while child will be in care:
I hereby authorize the childcare operation to allow my child to leave the childcare operation ONLY with the following persons. Please list name & telephone number for each. Children will only be released to a pa rent or a person designated by the parent/guardian after veri fication of ID.
AUTHORIZATION FOR EMERGENCY MEDICAL ATTENTION
In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Child daycare operations are public accommodations under the Amer icans with Disabilities Act (ADA), Title III. If you believe that such an operation may be practicing discrimination in violation of Title III, you may call the ADA Information Line at (800) 514-0301 (voice) or (800)-514-0383 (TTY).
Varicella (chickenpox) vaccine is not required if your child has had chickenpox disease. If your child has had chickenpox, please complete the statement: