Ready Set LEARN Early Childhood Learning Center, LLC: IMPORTANT CHILD INFORMATION

This document will be located in your child’s classroom so the teacher may have all pertinent information for your child readily available. Please be sure to complete this page accurately.

Child’s Name: ______Sex: M F Birth date:______

Address: ______Zip ______

Parent Name: ______Phone# ______

Cell# ______

Occupation: ______Employer ______

Phone # ______

Parent Name ______Phone# ______

Cell# ______

Occupation: ______Employer ______

Phone# ______

LOCAL EMERGENCY CONTACTS [other than parent or doctor]

Name: ______Address: ______

Phone# ______

Name: ______Address: ______

Phone# ______

PERSONS AUTHORIZED TO TAKE CHILD FROM RSL:

ATHORIZATION FOR EMERGENCY MEDICAL CARE:

I understand I will be notified at once in case of accident or illness to my child, and I will make arrangements for medical care of my child with the physician or hospital of my choice. If I cannot be reached to make necessary arrangements, or in a critical emergency requiring medical care, I hereby authorize RSL to contact the following physician for emergency treatment of my child.

Dr.______Phone# ______

Preferred Hospital: ______

List ALL known allergies: ______

Media Policy

In order to comply with the Data Protection Act 1998 we must obtain written parental consent before we take photographs of your child. Please complete this form and return it to Ready Set Learn.

I hereby consent to the use of any photographs/video tape taken of my child by Ready Set Learn or the media for the purpose of advertising or publicizing events, activities, facilities and programs of Ready Set Learn in newspapers, newsletters, website, or other publications, television, radio and other communications and advertising media.

By law, Ready Set Learn protects the privacy of the students and is prohibited from releasing students’ personal information.

Please mark any of the choices below and return to school.

____ Yes, I give permission to photograph, videotape, or audio record my child. I also give permission to display my child’s school work and photographs including class pictures. I also give permission to publish my child’s photography or school work on any website or internet page for which the photo may be requested.

____ Yes, I give permission to photograph, videotape, or audio record my child. I also give permission to display my child’s school work and photographs including class pictures. I DO NOT give permission to publish my child’s photography or school work on any website or internet page for which the photo may be requested.

____ I do not give permission for my child to be photograph for any school publication, news purpose, including school composite photos.

Please Print

Signature: ______Print Parent’s Name: ______