Kindergarten Safety Attendance Form
Please complete this form each day to ensure the safety and well-being of all children in our care.
Child's Full Name
*
First Name
Last Name
Date of Attendance
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Class/Group
*
Please Select
Preschool
Pre-K
Kindergarten
Other
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Drop-Off Time
*
Hour Minutes
AM
PM
AM/PM Option
Pick-Up Time
*
Hour Minutes
AM
PM
AM/PM Option
Who will pick up the child today?
*
Select any of the following symptoms your child has experienced in the last 24 hours:
*
Fever
Cough
Runny nose
Sore throat
Shortness of breath
None of the above
Other
Does your child have any allergies or medical conditions we should be aware of? If yes, please specify.
Additional notes or instructions for staff (optional)
Parent/Guardian Signature
*
Submit Attendance
Submit Attendance
Should be Empty: