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Child Care Forms | Department of Human Services
The forms found below are available in PDF format. Can't find the form you're looking for or need addtional information? Please contact the Regional Child Development Office nearest you.
parent signature is required for each item below to indicate parental consent. obtaining emergency medical care. admin. of minor first-aid procedures. walks and trips. wading. …
parental consent form (parents signature required next to each item) obtaining emergency medical care administering of minor first aid procedures . walks/trips/swimming/wading …
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HEALTH INSURANCE COVERAGE FOR CHILD or MEDICAL ASSISTANCE BENEFITS. POLICY NUMBER (REQUIRED) PARENTS SIGNATURE IS REQUIRED FOR EACH ITEM …
Health Insurance Coverage or Medical Assistance Benefits. Policy Number (Required) PARENT'S SIGNATURE IS REQUIRED FOR EACH ITEM BELOW TO INDICATE PARENTAL …
Parental consent for EMERGENCY MEDICAL CARE for child * CONSENT FOR ADMIN. OF MINOR FIRST AID PROCEDURES * Consent for PHOTOGRAPHS FOR USE IN CAS …
EMERGENCY CONTACT / PARENTAL CONSENT FORM. DIRECTIONS: Please print all information. Per DPW regulations all sections must be completed; there can be No Blank …
Signature of Parent/Legal Guardian Date I, the Parent/Legal Guardian agree to update the emergency contact/parental consent from information whenever changes occur or every 6 …
EMERGENCY CONTACT/PARENTAL CONSENT FORM . 55 PA Code Chapters 3270.124 (a) (b); 3270.181 & 182; 3280.124 (a) (b); 3280.181 & 182; 3290.124 (a) (b); 3290.181 & 182 ...
Mar 2, 2021 · parent/guardian's signiture is required for each item below to indicate parental consent periodic review (every 6 months) date signature of parent/guardian date signature of …
emergency contact parental consent form 55 pa code chapters 3270.124(a)(b), 3270.181 & 182, 3280.124(a)(b), 3280.181 & 182, 3290.124(a)(b), 3290.181 & 182 ... father’s name/legal …
medical/ dietary info necessary in emergency situation medications/special conditions additional information on special needs of child health insurance coverage for child or medical assistance …
PARENTAL CONSENT IS REQUIRED FOR EACH ITEM BELOW. PLEASE PRINT THIS FORM AND INITIAL EACH ITEM. ______ OBTAINING EMERGENCY MEDICAL CARE ______ …
HEALTH INSURANCE COVERAGE FOR CHILD or MEDICAL ASSISTANCE BENEFITS. POLICY NUMBER (REQUIRED) PARENT'S SIGNATURE IS REQUIRED FOR EACH ITEM …
emergency contact / parental consent form 55 pa code chapters 3270.124 (a) (b), 3270.181 & 182; 3280.124 (a) (b), 3280.181 & .182; 3290.124 ... walks and trips transportation by the …
As parent/guardian, I consent to have my child receive first aid by facility staff and, if necessary, be transported to receive emergency care. I will be responsible for all charges not covered by …
Note: Parents and guardians should designate themselves as designated custodians. Friends, neighbors and other relatives may also be designated. PLEASE PRINT CLEARLY.
EMERGENCY CONTACT / PARENTAL CONSENT FORM. *This form is to be signed at Calvary Care/WVP at time of registration payment.
Apply for a Child's U.S. Passport - Travel
Oct 2, 2024 · One parent can't go in person (but both of you have custody) Submit a Statement of Consent: Form DS-3053. The parent that cannot apply with the child must: Sign and date …
DIRECTIONS: Please print all information. Per DPW regulations all sections must be completed; there can be No Blank areas. If a section does not apply to your child, please put NONE IN …
ALLERGIES (INCLUDING MEDICATION REACTIONS) MEDICAL OR DIETARY INFORMATION NECESSARY IN AN EMERGENCY SITUATION MEDICATION, SPECIAL CONDITIONS. …
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