In case of an emergency, who can we call if we are unable to reach you
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Medical Statements and Consent
Note: All allergies/medical conditions must be stated on the child's medical form. Additionally, a "Standing Order" from the Pediatrician will be required in order to administer an Epi-Pen, Benadryl, or any Asthma medication. Your child will not be admitted without it.
New York department of health requires that all children are vaccinated for school entrance.
I, hereby, authorize Petits Poussins Daycare to provide care for my child.
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I declare to the best of my knowledge that all statements made in this application are true.
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