The Learning Station Registration Package Step 1 of 2 50% The Learning Station Registration PackageChild’s Name/ Nombre del hijo First Last Gender:Male/ NiñoFemale/ NiñaDay of Birth/ Dia de NacimientoAllergies/ AlergiasAddress / DirecciónHome phone/ Teléfono de la casaMother name / Nombre de la madreCell / Work phone / Teléfono del trabajoParent Email Father name / Nombre del padreCell/ Work phone / Teléfono del trabajoParent Email ProgramHours of care / Horas de cuidadoDays of care / Dias de cuidado: Mon Tues Wed Thurs Fri Sat Meals served / Comidas servidas: Breakfast Am Snack Lunch Pm Snack IN CASE OF EMERGENCY / EN CASO DE EMERGENCIAName / NombreAddress / DirecciónPhone/ TeléfonoRelationship / ParentescoPERSONS AUTHORIZED TO PICK-UP CHILD / PERSONAS AUTORIZADAS A RECOGER EL NINO (A)Name / NombreRelationship / ParentescoPhone/ Teléfono SLEEPING AND NAPPING ARRANGEMENTCheck the box beside the statement: I understand that my child while under the care of The Learning Station will be napping on a (Cot, mat, bed or crib) in the area of The Learning Station. My child will be supervised. If my child is an infant, I also understand that my child will be placed on his/her back to sleep. CONSENT FOR EMERGENCY MEDICAL TREATMENTCheck the box beside the statement: I do hereby give authority to the daycare program staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. The provider Cira Carreno . and staff may take my child for short walking trips and other activities checked below as par of the Day Care program activities. Provider’s Backyard Playground Other (with notification) Name Parent/ GuardianSignatureDate Date Format: MM slash DD slash YYYY
