Authorizations and permissions

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Authorizations and permissions

  1. 1. Authorization and Permission Form for _______________________ (child’s name)I/We _____________________________________________, hereby grant permission to Yasmeen Nasira ofAlif-Ba-Ta Learning Center to providethe 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. Initial to Initial to I/We give permission for my child to participate in each of the following activities for no more than 2 hours Approve Deny 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 Gaming systems 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 anambulance for medical or surgical care for my/our child __________________________________ (child’s name), should an emergency arise. It isunderstood that a conscientious effort will be made to locate the parents/guardians before emergency action will be taken, but if this is notpossible, the expenses of emergency medical treatment or care will be accepted by the parents/guardians. Notarization is required annually toprovide the childcare provider with authorization to give medical authorization to emergency/health professionals:_______________________________________ _____________________Parent/Guardian Date_______________________________________ _____________________Parent/Guardian DateSubscribed and affirmed before me this ____________ day of ___________, 20__, in the County of __________________________, State ofColorado.______________________________________Notary PublicMy Commission Expires: _____________________________

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