Early Childhood Health Assessment Record (Birth thru 5 years)

Required Forms regarding your childs immunization, health and medical conditions.

Parent/Guardian Authorization for the Administration of Non-Prescription Topical Medications by Child Care Personnel Permission for non-prescription topical medications be administered to your child by a child care staff member. This authorization is limited to the following topical medications: 1. Diaper changing or other ointments free of antibiotic, antifungal or steroidal medications, 2. Medicated powders, and 3. Teething, gum, or lip medications.

Authorization for the Administration of Medication by Child Day Care Personnel and Medication Administration Record (MAR) In Connecticut, licensed Child Day Care Centers, Group Day Care Homes and Family Day Care Homes administering medications to children shall comply with all requirements regarding the Administration of Medications described in the State Statutes and Regulations. Parents/guardians requesting medication administration to their child by daycare staff shall provide the program with appropriate written authorization(s) and the medication before any medications are dispensed. Medications must be in the original container and labeled with child’s name, name of medication, directions for medication’s administration, and date of the prescription. All unused medication will be destroyed if not picked up within one week following the termination of the authorized prescriber’s order.

Emergency Medical Care Permission

Forms for emergency care; including insurance and preferred physician information.