Wareham Early Childhood Education and Development Corp.

Parent Consent/Acknowledgment Form

I give permission to Wareham Child Care Staff:

I. to bring my child:

_________ on supervised field trips requiring transportation. I understand that I will be informed in advance of any field trip as to destination, approximate time of return and method of travel. I understand that this information will be posted at the center as well.

________ on supervised walking trips.

________ to the beach.

II. _____ to take photographs of my child participating in center activities. These photos will be used for education information or publicity only and will not be used for commercial purposes.

________ I give permission for these photos to appear on the warehamchildcare.org website. (no names will ever be used)

III. _________ to test my child’s:

______ hearing ___ vision _______ developmental abilities via a standardized testing tool.

______ include my child in an authorized observation assignment undertaken by an individual engaged in Teacher-Training, Nursing or Psychology programs. It is my understanding that the above-mentioned individuals will abide by the rules of the center regarding confidentiality, etc.

IV. in case of accident or extreme emergency:

______ in case of accident or emergency, if I cannot be reached, I give my permission to contact my family physician and to follow his instructions. If neither my family physician nor I is available, I give permission to bring my child to the nearest emergency room (Tobey Hospital) to be treated by the physician on duty with the understanding that staff will continue to reach me for further directions.

_____ in extreme emergency, I give permission for medical treatment, general anesthecia and surgery when necessary.

V. Sun Care:

_____ to apply NO-AD sun block SPF 45+ on my child between the months of May – Oct. to protect him/her from the harmful rays of the sun. I have applied this brand previously without any adverse skin reactions.

____ I prefer to use my own brand ___________________________ and will send this in labeled with my child’s name.

VI. Literature/Handbooks

I acknowledge that I have received:

____ Program evaluation (annually)

____ Parent hand-book (Includes health and safety requirements, social service plans,, behavior management plan, parental rights form)

Parent: ________________________________ Date: ___________________________

Child’s Name: ________________________________________________________

Revised: 5/03