Emergency Persons. These should be local persons who may be notified in case of emergency or illness when the parents or other caregivers are not available. Name Relationship with Child Work # Address Home # Name Address Relationship with Child Work # Home # Name Relationship with Child Work # Address Home #
Emergency Persons. In addition to the leave hereinbefore prescribed for other than shift workers, employees engaged as emergency persons who make agreements in writing with their employers to hold themselves in readiness to do overtime work at all hours shall be allowed one week's leave exclusive of statutory holidays, if any such holidays fall within the period of annual leave.
Emergency Persons. These should be local persons who may be notified in case of emergency or illness when the parents or other caregivers are not available. Name Relationship Work # Address Home # Name Relationship Work # Address Home # Name Relationship Work # Address Home# Release: May the participant leave the Program with the persons listed above? (Please check below) Yes, he/she may depart with any of the persons listed No, he/she may not leave with the following person(s) (include any person not listed): Information: Are there any eating problems or food allergies? What types of foods are appropriate for snack? How does the participant get along with others? What forms of discipline are appropriate? What makes the participant upset? How do you suggest we calm the participant down? Does the participant tire easily? Can the participant be aggressive? Explain: Is the participant sensitive to any stimulus we should know about? Please give any further information that you believe will be helpful to staff in understanding and caring for the participant: Diapered? Yes No Work on Toilet training: Yes No Note: **Participants must supply diapers and/or feminine hygiene products.* Other siblings: Name Date of Birth Enrolled in program? Medical Information: Diagnoses: Allergies (food, medication, bees) Chronic or recurrent illnesses or disorders: Are medications taken for these illnesses listed above? If so, please state the name of the drug and the dosage. Will the medication need to be given during program hours? Yes No If yes, when will it need to be given? Describe how. What should we (you) do if there is a problem related to his/her medical condition during program hours? What are the signs of problems that may occur? Please list an emergency phone number: Doctor’s Name: Phone # What hospital do you prefer? Insurance Company Policy Holder’s I.D.
