IMMUNIZATION RECORDS
(Please supple a photo-copy of child’s immunization records from CRD Health)
Your child cannot attend daycare until all Immunization records have been supplied to us.
We choose not to immunize or are on a delayed schedule (Please sign with signature): _________________
______________________________________________________________________________________
YOU THE PARENT/GUARDIAN ARE RESPONSIBLE FOR KEEPING THIS RECORD UP TO DATE/PLEASE SUPPLY A PHOTO COPY OF ANY NEW VACCINATIONS YOUR CHILD RECEIVES SO IT CAN BE ADDED TO THIS CHART.
I HEREBY GIVE MY CONSENT FOR A STAFF MEMBER OF LITTLE MIRACLES TO CALL A
MEDICAL PRACTITIONER OR AMBULANCE FOR MY CHILD _________________________IN
THE CASE OF AN ACCIDENT OR ILLNESS IF I CANNOT IMMEDIATELY BE REACHED.
____________________________________________ _______________________
{PARENT/GUARDIAN SIGNATURE} (DATE)
Information supplied on this form is for the custody and control of the care facility
collecting such information as required in the Child Care Licensing Regulations.
