6. Authorization and Permission Form for _______________________ (child’s name)
I/We _____________________________________________, hereby grant permission to Yasmeen Nasira of Alif-Ba-Ta Learning
Center to provide the following activities for our child by initialing & signing below.
1. I/We hereby grant permission for our child to use all of the indoor and outdoor play equipment and to participate in
all of the activities of this childcare home. ______
2. I/We hereby grant permission for our child to sleep in a nap room on a bed, playpen, mat or cot provided. ______
3. I/We hereby give permission for our child to leave the childcare premises under the supervision of a responsible adult
for neighborhood walks and other scheduled and unscheduled excursions. Permission forms for each trip are not
required. ______
4. I/We understand that all field trip expenses are the parent’s responsibility and agree to this as it is stated in the policy
statement of this child care home. I/We also understand that if a field trip will take place that the provider will give
advance notice and a separate permission form to be signed with the details of the trip. I also understand that if I
choose for my child not to attend, that it is my responsibility to find alternate care for that day without childcare
reimbursement from the provider for the fieldtrip. ______
5. I/We give permission for our child to have sunscreen applied on exposed skin areas before going outside on sunny
days. Sunscreen is supplied by the parent/provider and applied per stated in the health policies handbook. ______
6. I/We give permission for over the counter products and topical to be used on our child for preventative purposes
including but not limited to skin lotion, diaper cream/ointments, Orajel, Neosporin, Chapstick, or ___________ and
______________.
7. I/We GIVE/DO NOT GIVE (circle one) permission to introduce new foods to my child before the age of 12 months.
Parents will keep the provider informed of the foods being introduced. ______
8. I/We give permission to work on potty-training my child once they are determined ready for this process. I
understand that a child seat will be used on a regular toilet if needed. ______
11. Initialto InitialtoDeny I/We give permission for my child to participate in each of the following activities for
Approve no more than 2 hours each day. All media programs contain age-appropriate content
(G or PG ratings) and will not contain violence, profanity or other inappropriate
content.
A Television
B Video
C Gamingsystems
D Computer
E Music &Movement
F Telephone (real) for the purpose of:
I/We _______________________________________________, authorize Yasmeen Nasira of Alif-Ba-Ta Learning Center to call a
doctor, 911, or an ambulance for medical or surgical care for my/our child __________________________________ (child’s
name), should an emergency arise. It is understood that a conscientious effort will be made to locate the parents/guardians
before emergency action will be taken, but if this is not possible, the expenses of emergency medical treatment or care will be
accepted by the parents/guardians. Notarization is required annually to provide the childcare provider with authorization to
give medical authorization to emergency/health professionals:
_______________________________________ _____________________
Parent/Guardian Date
_______________________________________ _____________________
Parent/Guardian Date
Subscribed and affirmed before me this ____________ day of ___________, 20__, in the County of
__________________________, State of Colorado.
______________________________________
Notary Public
My Commission Expires: _____________________________

7. Child Release Authorization
I understand that every effort will be made to contact me. In the event the provider is unable to reach me I authorize
the following designate(s) to pick up my child. I understand designate(s) must be over the age of 18 years and have a
valid state issued driver’s license and an age appropriate vehicle child restraint. I will instruct my designate(s) to
bring their I.D. with them each time they are needed to pick up my child. I also understand that any additions to my
Child Release form must be done in writing prior to needing a new addition to pick my child up. I understand
without written consent the provider cannot release my child to another person not listed.
Child’s name: ________________________________________ DOB: _________________________
The following persons are authorized to pick up my child:
1stPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
2ndPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
3rdPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
4thPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
5thPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
_________________________________ _______________________________
Parent/Guardian signature Date
_________________________________ _______________________________
Parent/Guardian signature Date

8. PERMISSION TO PHOTOGRAPH FORM
I, ________________________________________________________________________________________
(parent’s or guardian’s name)
give permission for Alif-Ba-Ta Learning Center
to photograph my child/ren, _____________________________________________________________
(child’sname)
for the following purposes:
(Pleasecheckone)
Type of Use:
GrantPermission Decline Permission
StillPhotographs:
Display in provider’s personal scrapbook
Give photographs to current clients
Display in facility’s scrapbook or bulletin
boards, shown to current and
prospective clients
Display still photos on facility’s website *
Use still photos in promotional materials
Videos:
Give video to current parents
Display video on facility website
Use videos in promotional materials
Other (pleaselist):
* only first names and possibly last initials (in the event of two or more children with the same first
name) will be displayed on the facility website.
I understand that it is my responsibility to update this form in the event that I no longer wish to
authorize one or more of the above uses. I agree that this form will remain in effect during the
term of my child’s enrollment. By signing below, I also agree that this is a legally binding form,
and providing false information could be grounds for termination of preschool services, forfeiture
of retainer, or both.
Father/Guardian’sSignature Date
Mother/Guardian’sSignature Date
Alif-Ba-Ta Learning Center Date

10. School Transportation Release
__ Check if Non Applicable to this child
__ Check if child walks to a bus stop
__ Check if School provides bus service
Child’s Name: ______________________________ Days Transportation Needed: M T W R F
School Drop Off Time: ______________ School Pick Up Time: ______________
Name & Address of School: _______________________________________________________
School Telephone #: ____________________ Teacher’s Name: ____________________
Grade: __________ Track: _______________ Bus Stop Location:
________________________________________
Before School Activity: ______________________ Day(s) Transportation Needed: M T W R F
Responsible Adult & Phone: _____________________________ Drop Off Time: ____________
After School Activity: _______________________ Day(s) Transportation Needed: M T W R F
Responsible Adult & Phone: _____________________________ Drop Off Time: ____________
I/we _____________________________________ have/have not requested my childcare provider
transport my child to school/preschool.
I/we give/do not give permission to the provider to allow my child to walk to the bus stop by themselves or
with other school-age children from the child care home, if any.
I/we understand it is my responsibility as the parent, to notify my childcare provider in advance and in
writing of any changes in the school transportation schedule.
I/we understand that it is my responsibility to provide the childcare provider a school calendar prior to the
start of school each year.
I/we understand that is my responsibility as a parent, to notify my childcare provider immediately in the
event the school sends my child home ill.
I/we, the undersigned parent(s) / guardian(s), do understand that school transportation is provided as a
special service.
I/we will not hold our childcare provider responsible for any problem that may arise due to weather,
mechanical problems with the child care vehicle, scheduling conflicts, etc.
If child is tardy from expected arrival time to the child care provider’s home, the provider will contact the
parent or guardian. The Parent or Guardian is responsible to find the whereabouts of their child.
__________________________________ ___________________________________
Parent/Guardian Parent/Guardian
__________________________________ ___________________________________
Date Date