Forms

Download The Right Form When You Need It

These are available to download here, we do ask that you fill them out and submit them online!!
All of these forms are also available in hard-copy format at the school, as Plan B!! xo

Child Care Registration Form

This form is required for each child enrolling in our preschool. It must be renewed annually along with one of the Fall Registration Forms below. Although your information may stay the same year to year, we discard old forms, so please fill it out completely.

Complete Form

Child Care Registration Form

To the Parent or Guardian: This form must be completed for each of your children who will be enrolled in the program, and must be updated whenever information changes.

Date of Child's Enrollment

Child's Name

Child's Date of Birth

Street Address

Apartment (optional)

City

State

Zip

Phone Number

Identifying Information of Parent/s or Guardian/s Legally Responsible for Child

Parent / Guardian #1 -
Name

Street Address

Apartment (optional)

City

State

Zip

Home Phone Number

Parent / Guardian #2 -
Name

Street Address

Apartment (optional)

City

State

Zip

Home Phone Number

Please Indicate Where Parent/Guardian Above Can be Reached While Child is in Care. Include Name, Address and Phone Number of Business if Applicable.
Parent / Guardian #1
Business Name

Street Address

Apartment / Suite / Other (optional)

City

State

Zip

Phone Number

Hours

Parent / Guardian #2
Business Name

Street Address

Apartment / Suite / Other (optional)

City

State

Zip

Phone Number

Hours

Special Instructions for Reaching Parent/Guardian

Emergency Contact(s)

You (parent/guardian) are required to list at least 1 person with whom you would feel comfortable leaving your child, and who could assume responsibility for your child if you could not be reached immediately in an emergency, or if for some reason you could not pick up your child and were unable to communicate with the program. Examples: if your child were sick and you were not accessible, or if you experienced sudden illness between work and picking up your child.

Emergency Contact #1
Name

Relationship

Street Address

Apartment (optional)

City

State

Zip

Phone Number

Emergency Contact #2
Name

Relationship

Street Address

Apartment (optional)

City

State

Zip

Phone Number

Non-Emergency Alternate Pick-Up Contact(s)

I, , authorize the following individuals(s) to pick up my child from the program on a non-emergency basis.

Alternate Contact #1
Name

Relationship

Street Address

Apartment (optional)

City

State

Zip

Phone Number

Alternate Contact #2
Name

Relationship

Street Address

Apartment (optional)

City

State

Zip

Phone Number

Licensing Staff & Medical Information

The licensing authority for this program is the bureau of licensing and certification, child care licensing unit. Child care programs are required to post a copy of the statement of findings and corrective action plan for the most recent visit in a location which is accessible to parents, and must maintain copies of the statement of findings and corrective action plan for the preceding visit and make them available to parents to review upon request. Statements of findings and corrective action plans are also available online at https://nhlicenses.nh.gov/verification/Search.aspx?facility=’Y or by calling 603-271-9025 or 1-800-852-3345, extension 9025.

During visits to programs licensing staff speak with children regarding the care they receive at the program if in the judgment of the licensing staff the children’s response would be valuable in determining compliance with licensing rules. Licensing staff are experienced in working with children and trained to speak with children in a manner that is respectful and non-leading. Children will remain with their class or group during these conversations with licensing staff, and at no time will a child be forced to speak with a licensing coordinator.

Licensing Staff Permission
If licensing staff believes your child may have specific information regarding an alleged event at the child care program, and determines that it is best to interview your child separately and not with their class or group, please indicate your preference among the following options:I give permission for child care licensing staff to interview my child at the child care program separate from their class or groupI wish to be notified prior to child care licensing staff interviewing my child at the child care program separate from their class or groupI do not give permission for child care licensing staff to interview my child at the child care program separate from their class or groupFor more information about Child Care Licensing please visit: https://www.dhhs.nh.gov/oos/cclu/index.htm

Any chronic conditions, allergies, or medications that could be important in case of sudden illness or injury

Child's Usual Physician

Physician's Phone Number

Physician's Address

Emergency Medical Treatment Authorization
I hereby give permission for the staff of "Dynamic Foundations" for Families to provide simple first aid treatment to my child, when necessary. In the event of a more serious illness or injury, I give permission for my child to be transported to a hospital or other emergency medical facility to receive medical treatment. I also authorize ambulance/rescue squad attendants to administer such treatment as is medically necessary, and I authorize licensed health practitioners working in the hospital or emergency medical facility to examine and provide emergency medical treatment to my child if warranted. I understand that I will be contacted by child care program personnel as soon as possible regarding any emergency involving my child.

Parent/Guardian Signature

Date

I agree that I am signing this form electronically. I also agree that the electronic signature appearing on this form is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility. To withdraw consent to sign this form electronically and to request a paper copy, please contact Dynamic Foundations for Families

Calling Card Form

This form is required for each child enrolling in our preschool. It must be renewed annually. Please be sure to enter two primary contacts with very clear phone numbers, as well as two alternates in the event you cannot be reached in an emergency.

Complete Form

Emergency Call Card

Your Name

Your Email

Home Phone

Spouse / Secondary Guardian's Name

Child's Name

Birthday

Street Address
Apartment (optional)
City
State
Zip

Medical Information

Allergies

Medical Notes

Dietary Restrictions

Emergency Contacts

Emergency Contact to Call First

Phone Number

Relationship

Emergency Contact to Call Next

Phone Number

Relationship

Alternate Pick-Up Contact(s)

You are required to list person(s) with whom you would feel comfortable leaving your child, and who could assume responsibility for your child if you could not be reached immediately in an emergency, or if for some reason you could not pick up your child and were unable to communicate with the program.
Eg)If you were unexpectedly detained and couldn't contact us or if you experienced sudden illness between work and picking up your child.

Alternate Picker-Upper #1

Relationship

Alternate Picker-Upper #2

Relationship

Special Love Notes

Do you call your child by a nickname?

Is there anything special we can do for your child here at school?

Favorite toys, blankets, "binkies" from home

Favorite activities/games

Favorite songs/stories

If upset, how does the child especially like to be comforted?

Special words/phrases you use

Do you have any pets at home?

Special names for the Grandparents

Any other love notes that might help in easing the transition to school?

Date Submitting this Form

Health / Physical Form

NH State Regulations requires us to have documented up-to-date immunization forms for each child. Bring this two-page form with you to your child’s annual physical. Your pediatrician may fill it out this form completely, or submit their own immunization chart.

Download

Medication Form

This form must be completed prior to the administration of any medication here at the school.

Download

Download The Right Form When You Need It

Child Care Registration Form

Calling Card Form

Health / Physical Form

Medication Form

A Quality Learning Center

Contact Us

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Download The Right Form When You Need It <img decoding="async" src="/wp-content/uploads/2019/10/blue-line.png" />

Child Care Registration Form

Child Care Registration Form

Identifying Information of Parent/s or Guardian/s Legally Responsible for Child

Emergency Contact(s)

Non-Emergency Alternate Pick-Up Contact(s)

Licensing Staff & Medical Information

Note to Parent/s or Guardian/s (click to collapse)

Calling Card Form

Emergency Call Card

Medical Information

Emergency Contacts

Alternate Pick-Up Contact(s)

Special Love Notes

Health / Physical Form

Medication Form

A Quality Learning Center

Contact Us

Follow

Download The Right Form When You Need It