CHILD INFORMATION FORM

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CHILD’S LEGAL NAME:
MAIN CONTACT EMAIL:
CHILD’S HOME ADDRESS:
PARENT/GUARDIAN 1 ADDRESS:
PARENT/GUARDIAN 2 ADDRESS:

IN THE EVENT THAT WE NEED TO REACH YOU AND/OR HAVE YOUR CHILD PICKED UP FROM SCHOOL, PLEASE LIST EMERGENCY CONTACTS IN THE ORDER YOU WISH TO HAVE THEM CALLED (YOURSELF INCLUDED). ALL CONTACTS ON THIS LIST ARE ABLE TO REMOVE YOUR CHILD FROM SCHOOL.

PERSONS LISTED ARE CONTACTS THAT MAY NOT HAVE CONTACT WITH YOUR CHILD OR REMOVE THEM FROM SCHOOL (PLEASE ENSURE LEGAL PAPERWORK (IF APPLICABLE) IS PROVIDED TO GATEWAY PRIOR TO YOUR CHILD’S FIRST DAY OF SCHOOL AND UPDATEDED AS NEEDED.
IF CHILD REQUIRES MEDICATION ON SITE WHILE AT SCHOOL, PLEASE CONTACT GATEWAY PRIOR TO YOUR CHILD’S FIRST DAY OF SCHOOL
PLEASE BE SPECIFIC AND LIST ALL SYMPTOMS OF EXPOSURE. IF AN EPI-PEN OR EMERGENCY MEDICATION IS PRESCRIBED, GATEWAY IS REQUIRED TO HAVE A CURRENT PRESCRIPTION REMAIN ON SITE THROUGHOUT THE YEAR. PLEASE CONTACT GATEWAY PRIOR TO THE FIRST DAY OF SCHOOL FOR REQUIRED FORMS AND INSTRUCTIONS.
PARENT HANDBOOK CONFIRMATION
I HAVE READ AND UNDERSTAND THE POLICIES LISTED WITHIN THE PARENT HANDBOOK. I UNDERSTAND I MAY REQUEST A PAPER HANDBOOK FROM THE OFFICE AND ACCESS THE HANDBOOK ONLINE THROUGHOUT THE YEAR FOR REFERENCE.
PHOTO/VIDEO CONSENT
DO YOU PROVIDE YOUR CONSENT FOR GATEWAY SCHOOL FOR YOUNG CHILDREN TO USE MY CHILD’S PHOTO/VIDEOS ON THEIR SOCIAL NETWORKING PAGES, WEBSITE, BROCHURES, ADVERTISING OR OTHER CONTENT.
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TO COMPLETE YOUR CHILD’S ENROLLMENT, PLEASE ATTACH THEIR IMMUNIZATION RECORDS, CIS FORM, SIGNED EXEMPTIONS, CONDITIONAL STATUS, OR LETTER OR OTHER DOCUMENTS REGARDING IMMUNIZATION STATUS OF YOUR CHILD. YOUR CHILD’S RECORDS ARE AVAILABLE THROUGH THEIR PHYSICIAN OR ONLINE AT DOH.WA.GOV. GATEWAY IS REQUIRED TO COLLECT CURRENT IMMUNIZATION RECORDS TO ENSURE THE HEALTH AND SAFETY OF ALL STUDENTS. PLEASE CONTACT MISS ANDREA AT ANDREA@GATEWAYPRESCHOOL.NET WITH ANY QUESTIONS RELATED TO IMMUNIZATIONS.
THE ABOVE LISTED INFORMATION IS ACCURATE. I WILL UPDATE GATEWAY WITH ANY CHANGES. I UNDERSTAND THAT GATEWAY PERSONNEL WILL ATTEMPT TO LOCATE THE ABOVE LISTED CONTACTS IN THE EVENT MY CHILD BECOMES ILL OR HURT WHILE IN ATTENDANCE. THE SCHOOL WILL ADMINISTER MINOR FIRST AID UNTIL ONE OF THE ABOVE CAN PICK UP MY CHILD. IN THE CASE OF AN EMERGENCY, MY CHILD WILL BE TRANSFERRED BY AMBULANCE TO KADLEC MEDICAL CENTER AND I WILL BE NOTIFIED AS SOON AS POSSIBLE. I PROVIDE PERMISSION FOR KADLEC MEDICAL CENTER TO ADMINISTER MEDICAL TREATMENT NECESSARY UNTIL MY ARRIVAL.