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Office of Children and Family Services | Home | OCFS

    https://ocfs.ny.gov/main/Forms/Day_Care/OCFS-LDSS-4433.dot
    CHILD IN CARE MEDICAL STATEMENT. To Be Completed By Licensed Physician, Physician Assistant or Nurse Practitioner. Name of Child: Date of Birth: / / Date of Examination: / / Immunizations required for entry into day care. Medical Exemption. The physical condition of the named child is such that one or more of the immunizations would endanger life or health.

Ohio Department of Job and Family Services CHILD …

    https://www.achildsgarden.us/assets/Medical-Form.pdf
    CHILD MEDICAL STATEMENT FOR CHILD CARE. Child’s Name (print or type) Date of Birth . Note: Sections A and B must be completed by the examining Health Care …

Ohio Department of Job and Family Services CHILD …

    https://www.owens.edu/childcare/forms-findlay/child-med-statement.pdf
    CHILD MEDICAL STATEMENT FOR CHILD CARE Child’s Name (print or type) Date of Birth This above named child has been examined, the immunization status recorded, …

CCMPL 92 (JFS 01305 Child Medical Statement Second …

    https://emanuals.jfs.ohio.gov/ChildCare/ChildCareManual/CCMPL/CCMPL-92.stm
    The JFS 01305 "Child Medical Statement for Child Care," the sample form, has been revised to comply with the requirements in section 5104.014 ORC. Implementation: Any …

Office of Children and Family Services | Home | OCFS

    https://www.ocfs.ny.gov/forms/ocfs/OCFS-6004.docx
    MEDICAL STATEMENT Child Care Programs I nstructions A signature is required on BOTH SIDES of this form. If the only role is a household member, complete ony the front …

Medical Statement of Child in Childcare - University at Buffalo

    http://ecrc.buffalo.edu/_docs/Medical-Statement-of-Child-in-Childcare.pdf
    statement from a parent, parents or guardian of the child stating that they object of the immunization of their child due to their sincere and genuine religious beliefs should be …

OCFS-LDSS-4433 Medical Statement of Child in Day Care

    https://www3.sunysuffolk.edu/forms/dss-4433.pdf
    Medical Statement of Child in Childcare (cont.) Summary of Physical Exam Include special recommendations to Day Care Providers On the basis of my findings as indicated …

Medical Release Form for Consent to Treat Your Kids - Verywell …

    https://www.verywellfamily.com/sample-medical-release-form-4158624
    Getting Started. Start by compiling all applicable information—including birth dates, medical history, and insurance information—for each of your children. Then, use …

Child Care Forms - Department of Human Services

    https://www.dhs.pa.gov/docs/For-Providers/Pages/Child-Care-Forms.aspx
    Child Care Forms (All forms are PDF downloads) Application for Certificate of Compliance for Center Group and Family New 2020 Disclosure statement.pdf; Child Care …

Forms | Missouri Department of Elementary and Secondary …

    https://dese.mo.gov/childhood/child-care/forms
    Child Care Enrollment Form Child Care Work Experience Child Care Enrollment For License-Exempt Facilities Clock Hour Training Credit Reassignment Emergency School …



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