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Childcare Profile Form from Improv Care
Please fill out ONE child profile form for EACH child. All information is strictly confidential.
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* Required
Email
*
Your email
Parent name(s), first and last:
*
Your answer
Child's name(s):
*
Your answer
Child's age
*
Your answer
Parents Email Address:
*
Your answer
Parents Cell phone number:
*
Your answer
Alternative number:
*
Your answer
Emergency contact person Name:
*
Your answer
Emergency contact person Phone Number:
*
Your answer
Allergies: type, high risk or low risk, treatment; please explain:
*
Your answer
Medical issues: please describe in detail:
*
Your answer
Restrictions: diet, rest, exercise, mobility, off-limit activities:
*
Your answer
Restricted foods:
*
Your answer
Regular or special routine requirements:
*
Your answer
Please share any additional information that you would like us to know about your child or family:
*
Your answer
Do you authorize Improv Care professional (s) to administer emergency first aid or medical treatment in case of emergency
*
Yes
No
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