ACCEPTANCE FORM
This is confirm that ______________________________________, (child) has been accepted for
Care by the provider and a place will be reserved until the first day of care which will begin on
________________________, 20____. A tuition deposit of $ ____________ has been received.
If the child is placed in Michele Bowers’ care, the entire deposit will be returned and used towards the child’s first and last weeks of care, upon giving a two week notice of the child’s termination of enrollment.
Dated ______________________________________, 20____
_____________________________________ ____________________________________
Parent or Guardian Parent or Guardian
_____________________________________
Provider
MEDICATION CONSENT FORM
Parental Release for Administration of Non-Prescription Medications
Child’s Name: _____________________________________________________________________
Medication:_______________________________________________________________________
Medication:_______________________________________________________________________
Medication:_______________________________________________________________________
Medication:_______________________________________________________________________
I, _______________________________________________ (parent/guardian), give permission for the above non-prescription medication to be given to my only as needed or per direction stated below and per instructions on the packaging. This medication may be given to child until (as needed, date specified, or until empty) _______________________________________________
_____________________________________________ ____________________
Parent/Guardian Date
MEDICATION CONSENT FORM
Parental Release for Administration of Prescription Medication
Prescription medication must have current information and the child’s name on the label.
Child’s Name: _____________________________________________________________________
Medication: _______________________________________________________________________
Condition for which prescribed: _______________________________________________________
Possible side effects to monitor: _______________________________________________________
________________________________________________________________________________
Dosage and time of administration: ____________________________________________________
Medication to begin (date) __________________________ unit (date) ________________________
Other remarks:____________________________________________________________________
I request the above medication be given to my child as ordered by the doctor.
____________________________________________ ______________________
Parent/Guardian Date
