Emergency & Permissions (Form)

Smiles Child Care

Emergency Contacts & Permissions

Colorado requires at least two emergency Contacts authorized to pick up your child. I would prefer if one of them is in Colorado.

Yes, my emergency contact can pick up my child from child care and take care of them until I am able.

Required Permissions

Medical Treatment Permission for Emergency

This form is to be filled out when you first enroll, and notarized within 30 days, and then updated yearly. It is important.

I hereby give Smiles Child Care Permission to have my child

Emergency information is kept on file at the daycare. If it is a case of illness or injury the information will be used to notify you or the person designated by you, or your child’s status.

If your child is injured while at childcare, first aid will be administered.

If treatment by a doctor is necessary, we will make every effort to contact you or the doctor you have chosen to treat your child.

Authorization for emergency treatment must be signed at the time of enrollment to ensure that in the event of an emergency, we can make sure your child receives the necessary emergency treatment they need.

It is very important that all emergency contact information is kept up to date and correct.

Please inform us immediately of any changes to keep your information current.

Parents are responsible for all costs involved in emergency medical treatment, including emergency transportation.

I also will NOT hold Smiles Child Care, the owner, any employees, or any other parents responsible for anything that happens to my child.

I grant permission to Smiles Child Care to make whatever emergency measures are judged necessary for the care and protection of my child while under their supervision.

I hereby authorize Smiles Child Care to act on my behalf in case of an emergency.

In the case of a medical emergency, I understand that my child may be transported to the local emergency room by Smiles Child Care, or by ambulance for treatment if the arriving EMT/Paramedics deem necessary.

If your child has minor injury, we will contact parents first and then contact emergency services if needed or wait for the parent's arrival to take the child to the doctor or hospital.

If necessary, 911 will be contacted first, depending on the severity of injury. Then we will contact the Department of Human Services, if needed.

If we cannot contact you, we will be required to call emergency services to take the child to the nearest hospital at the parent’s expense.

Emergency information is kept on file at the daycare. If it is a case of illness or injury the information will be used to notify you or the person designated by you, or your child’s status. If your child is injured while at childcare, first aid will be administered. If treatment by a doctor is necessary, we will make every effort to contact you or the doctor you have chosen to treat your child. Authorization for emergency treatment must be signed at the time of enrollment to ensure that in the event of an emergency, we can make sure your child receives the necessary emergency treatment they need. It is very important that all emergency contact information is kept up to date and correct. Please inform us immediately of any changes to keep your information current. Parents are responsible for all costs involved in emergency medical treatment, including emergency transportation. I also will NOT hold Smiles Child Care, the owner, any employees, or any other parents responsible for anything that happens to my child.

Field Trips/Off-Site Activities

I give my permission for my child to leave the daycare premises under the watchful supervision of Smiles Child Care to go on neighborhood walks and field trips. I understand that some of the field trips might be planned, some are unplanned, and some might have a fee incurred with them.

I give permission to Smiles Child Care to pick up and drop off my child to school and all the school events including talking to the school administration, talking to the teacher and attending any parent meetings.

Temporary custody

If the parents cannot come and pick up the child (ren), Spring Davidson &/or Ken Anderson, can keep the child(ren) if necessary for how long it is needed. If the parents are not able to take care of the child(ren) for any reason, sick, car accident, detained for any reason: Spring Davidson &/or can have temporary custody of the child(ren) until the parents are able to care for the child(ren) or other care is found, this includes all things necessary to properly care for the child, including clothing, nourishment and shelter. DHS will be notified and involved if necessary. After one-year, temporary custody may turn permanent if necessary.

Yes, I agree, If other care is not found, Spring Davidson &/or Ken Anderson can be granted full custody of the child(ren) if needed until myself or my contact people are able

No, I do not agree, If my child is not picked up within 15 minutes of their scheduled time and parents have not made contact, staff will call the emergency contacts. If we cannot reach anyone within 30 minutes after the scheduled time, we will notify local authorities or social services to pick up your child, and your family's contract with us will be immediately terminated.

Transportation

I give permission for transportation as part of child care activities when applicable

Photo & Media

I give permission for my child’s image to be used for program documentation and marketing (no names shared publicly), this includes Facebook and the Smiles Website

Infants (Under 2 years old)

Drop off early & Pick up late
Care Given for more than 50 hrs a week, more than 5 days a week or more than 12 hours a day
No Call No show
Overnights & Holidays
Field trips fees, expenses, and transportation
Medication, clothing, diapers, or additional items needed for care
Rides given to or from Smiles Child Care, school, or other places
Less than a 2 week notice given for withdrawing

Certification

I hereby grant permission for my child to use all the play equipment and participate in all the activities at Smiles Child Care

Consent to authorize all actions necessary for the proper care of the child, regarding their attendance at any public or private property, institute, or school.

Yes, I understand there are animals on the premise, and my child care interact with all animals, on and off of the premise.

Liability Waiver

You hereby release and agree to indemnify, defend, and hold harmless us, our employees, representatives, agents, and other parents, and directors from all claims or liability for damages and/or injuries incurred by your child(ren) in connection with childcare, preschool, & other services that we provide. You further acknowledge that you have reviewed and evaluated the risks and determined the use of the childcare we provide with full knowledge and acceptance of the risks. You agree with the use of the childcare we provide and participation in activities or events during such care and preschool. Shall be undertaken by your child(ren) at your sole risk, and we shall NOT be liable for any injuries or any damage to you or your child(ren), or be subject to any claim, demand, injury, or damages whatsoever, irrespective of cause of origin. We shall not be responsible for or liable for articles damaged, lost, or stolen, in or about our premises or on a field trip, or for loss or damages to any property.

If one or more provisions in this agreement are held to be unenforceable under applicable law, such provision shall be excluded from this agreement and the balance of the agreement shall be interpreted as if such a provision were so excluded and shall be enforced in accordance with its terms. If Smiles does not hold one or more provisions to standard or change them in any way, it does not mean that it is permanently changed or canceled or that nothing else changes in this contract.

At Smiles Child Care, we raise each other. Smiles Child Care and Preschool are places where educators, little learners, and family can thrive together. Through our commitment, we are transforming home care by delivering exceptional education within nurturing environments for the children in our communities. We are so thrilled that you have chosen us to join us on this journey. We acknowledge that we have received and reviewed the Smiles Child Care Contract and Handbook and agree to the terms and conditions contained within it.

Yes, I agree with everything that is in the Smiles Child Care Handbook and I have access to a copy of it.

Signature Block

By typing my name, I acknowledge this serves as my legal signature

Smiles Child Care

Spring Davidson

7350 Sullivan Circle

Colorado Springs, CO 80911

719-985-1678 Spring

719-930-5740 Ken

smileschildcare2026@gmail.com

smileschildcare.smilesearlylearning.com

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Smiles Child Care

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