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Infant Toddler Nursey
About
Home
About Us
Philosophy
Policies
Nutrition
Careers
Programs
Early Childhood Equity Fund (ECEF)
Preschool for All (PFA)
Preschool Promise (PSP)
Gallery
Tiedeman Ave Campus
Omolaso Preschool and Childcare
Grant Ave Preschool
Infant Toddler Nursey
Calendar
Exploring, learning, creating
Child's Name
*
First Name
Last Name
Parent/Guardian
*
First Name
Last Name
Parent/Guardian
*
First Name
Last Name
HEALTH INFORMATION
This child has a DANGEROUS, life-threatening allergy to the following:
*
...and all substances containing them in any form or amount, including the following kinds of items:
Include what medication you are providing; where it is located; is it given to staff?
Symptoms following exposure to a particular material can include:
*
Check all that apply.
hives and itchiness on any part of the body
nausea, vomiting, diarrhea
difficulty breathing or swallowing
panic or sense of doom
throat tightness or closing
swelling of any body parts, especially eyelids, lips, face or tongue
coughing, wheezing, or change of voice
fainting or loss of consciousness
Other
I understand why I have been asked to disclose the above information and I am aware of the risks or benefits of consenting or refusing to consent to this disclosure. I voluntarily agree that Education Explorers may post my child/teen’s picture, take the Emergency Measures, and share this information, as necessary, with health providers.
*
Yes, I have read and agree
Thank you!
