PLEASE FILL OUT COMPLETE INFORMATION ON EACH PARENT: PHONE AND WORK # (if applicable), SO WE CAN CONTACT YOU and EMAIL TO RECEIVE NEWSLETTERS AND BILLING. THANK YOU!
We have allowed for information for up to 4 siblings for this child. If your child has more than 4 siblings, please use the space at the bottom of this form to complete this information. Please fill out Sibling fields applicable to your family and then skip to the Child Specifics Section of this form. Thank you.
Child Specific Information
Days and Times in Care:
Persons to Contact WHEN YOU CANNOT BE REACHED - (Must list at least one emergency contact with address)
Your child will be released only to you (PARENTS) or other persons designated by you. Parent or other designated persons bringing the child to class or picking him/her up should make sure that a staff member is aware of the child's arrival and departure. Please list persons to whom you want your child to be released OTHER THAN YOURSELF. We would use these numbers in the event that your child becomes ill or injured and needs to be picked up from school, AND WE CANNOT REACH YOU AT ANY OF THE NUMBERS YOU HAVE PROVIDED ABOVE. Individuals listed should be notified that they will be asked for identification before your child is released to them.
Medical Release Information and Authorization for Emergency Medical Treatment
Permission for Administration of Medication
NOTICE: Parent must supply age appropriate medicine labeled with child's name
Personal Information Release
Permission to Photograph/Video Your Child
Permission to Post on St. John ECC Facebook pages and St. John Church/School Website
GANG-FREE ZONE: Under the Texas Penal Code, any area within 1,000 feet of a child care center is a gang-free zone, where criminal offenses related to organized criminal activity are subject to harsher penalties.