Day Care Application Form

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Day Care Application Form

The following forms must be completed and received before care begins:

* Signed Childcare Contract w/Registration Fee *Emergency Medical Form (Blue Card)
* Photo Release
* Field Trip Permission Form
* Discipline Policy
* Copy of Immunization Records

  • In the event it comes to the attention of Growing Minds of New York Inc., its officers, directors and agents, associated with the activity, that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I understand that I may be called to immediately pick up my child at the location of the activity.
  • In the event of an emergency, I hereby give Growing Minds of New York Inc., its directors or any employee permission to transport my child to a hospital for emergency medical treatment. However, I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers, contact:
  • Medications:

    My child is taking medication at present. My child will bring all such medications necessary, and such medications will be labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are as follows:

  • Enter your name and today’s date to indicate your acceptance of the Conditions of Day Care.