CENTER PLAY SCHOOL MANDATORY FORMS 

                                                                                                        

Center Play School Information / Emergency Form 2010-2011
 
Child’s Name: __________________________________
Age:________   Birth Date: _____________ Teacher: ________________
Home Address: ________________________________________________
Home Phone:_____________________________
Mother’s Name:________________     Work Phone:___________________
Father’s Name:_________________     Work Phone:___________________
Cell Phone: (mom) ___________________    (dad)____________________
E-mail address:______________________________________________
Emergency Names and Telephone numbers:
1. Name:______________   Relationship:______________________
Phone number:________________________
2. Name:________________   Relationship:__________________________
Phone number:________________________
 
Physician’s Name:____________________ Telephone number:
Allergies: (Please describe specifics) _______________________________ ____________________________________________________________
Food Restrictions: (Please describe specifics) ________________________________
Activity Restrictions? _____________________________________________________
Is your child toilet trained? ________   Bus______ Carpool_________
Has you child previously attended a playgroup/nursery school? _____________________
Tell us about your child (use the back if necessary)_______________________________ ________________________________________________________________________
Center Play School Emergency Medical Treatment Form 2009-2010
In case of emergency, I realize that the center will make every effort to contact me or any persons) whom I designate. In the event that no one can be reached, I authorize the JCC to seek medical assistance for my child; in addition, I/we give permission to hospitalize, secure proper treatment for, and or order injection, anesthesia, or surgery.
__________________________________________                 ____________________
Signature of Parent or Legal Guardian                                                 Date

 

 
 
 
 
Dear Parents.
In Keeping with recent amendments to New Jersey’s child care licensing requirements, we are obliged to provide you, as parent of a child enrolled at our center, with this informational statement.
The statement highlights, among other things: your right to visit and observe our center at any time without having to secure prior permission; the center’s obligation to be licensed and to comply with licensing standards; and the obligation of all citizens to report suspected child abuse/neglect/exploitation to the State’s Division of Youth and Family Services (DYFS).
Please read this statement carefully and the attached information and, if you have any questions, feel free to contact the center at 531-9100.
--------------------------------------------------------------------------------------------
I have read and understood the attached DYFS information.
Child’s Name ______________________________
 
________________________________                       _________________
Signature of Parent or Guardian                                    Date
 
Please sign and return this copy to the preschool office.

 


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JCC of Greater Monmouth County - 100 Grant Avenue - Deal Park, NJ - 732-531-9100
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