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Child's Medical Information and Vehicle Emergency Medical Information Forms

Child's Medical Information

Does your child have any physical limitations, mental health disorders, mental retardation, developmental disabilities, or behavior disorders which could limit or challenge the child's participation in the center's programs and activities?

If yes, specify:

Are there any special instructions in caring for your child?

If yes, specify:

Allergies

Does your child have allergies (insect, seasonal, medications, foods, etc.)?

If yes, specify:

Please list any foods that your child may be allergic or sensitive to as our center nutritionist uses this information. Please note that a doctor’s note and/or allergy form will be required. Parents may be required to bring in meals from home depending on the allergy and severity.

Child's Name

Food List:

Allergic reaction that occurs when ingested:

Does your child have an EpiPen?

If there are any special instructions concerning your child’s allergies or allergic reactions, please specify:

Your child's health, welfare, and safety are the primary concerns of the staff members at More Than Preschool. The information requested is very important to ensure that your child receives the necessary care required for them.