Childcare Profile Form from Improv Care
Please fill out ONE child profile form for EACH child. All information is strictly confidential.
Email address *
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 *
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