EMERGENCY CONTACT INFORMATION
HEALTH AND DEVELOPMENT INFORMATION
Please list any dietary restrictions your child may have:
Please list any allergies your child may have:
Please list any health issues your child may have (frequent headaches, sinus infections, earaches, etc.):
Please list any psychological diagnoses you feel our staff should know (for both safety and to best meet your child’s needs):
Please list any developmental issues or needs you feel our staff should know (for both safety and to best meet your child’s needs):
Please list any phobias or heightened sensitivities your child may experience:
Has your child experienced any major life events in the past year (I.e., birth of a sibling, death of a family member, divorce, moving, etc.)?
Please list any other health or development items you feel our staff should know:
HEALTH CONDITION FORMS
If the answer is 'yes' to any of the following questions, please contact firstname.lastname@example.org as soon as possible to discuss proper medical and/or legal protocol.
I give permission for my child to be included in any image recording connected with the school’s program which is purely intended for internal purposes. This might include posting to the internal-facing Facebook account, internal-facing Instagram account or ALC blogs that are intended to be shared with those inside the Heartwood ALC community. Please be aware it is possible that these forms of media may also be posted on the Internet at-large without the permission of Heartwood ALC.
I give permission for my child to be included in any image recording connected with the school’s program, specifically external-facing media. This might include postings to the external-facing Facebook account, external-facing Instagram account or ALC blogs that are intended to be shared with the ALC community worldwide. I understand that those images may be used as documentation on the school’s website, newsletter or marketing materials.