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TSNS Child Information Form

Please use the (+) button to view and complete each section. To add another section for a second child, click the (+) button again. 

Child Information

Parent/Guardian Information

Child Health Information

Please use these fields to specify information about all of your children. Please indicate which child you are referring to when applicable.

Small Group and Large Group Transportation Plan and Authorization

First Aid and Emergency Medical Consent

I authorize staff in the childcare program who are trained in First Aid/CPR to give my child First Aid/CPR when appropriate.

I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the program to transport my child to the nearest medical care facility and to secure necessary treatment for my child.

Emergency Contacts (In order to be contacted)

Developmental History and Background Information

Please fill in the information for your child as appropriate or write "N/A".

Health and Medical

Eating Habits

Toilet Habits

Sleeping Habits

Please note: The American Academy of Pediatrics has determined that placing a baby on their back to sleep reduces the risk of Sudden Infant Death Syndrome (SIDS). SIDS is the sudden and unexplained death of a baby under one year of age. If your child does not usually sleep on their back, please contact your pediatrician immediately to discuss the best sleeping position for your child. Please also take the time to discuss your child's sleeping position with your caregiver.

Social Relationships

Daily Schedule

Teeth Brushing Authorization

The Department of Early Education and Care of the Commonwealth of Massachusetts has legislated that all children who eat a meal or spend more than four hours at school be offered the choice of brushing their teeth while at school.

Parents may determine whether or not they want their child to participate. If yes, all children must bring in a labeled toothbrush and toothpaste in their lunchbox daily.

Photo/Video Consent

Electronic Signature

Tue, January 23 2018 7 Sh'vat 5778