Childcare Sleep Policy Acknowledgement Form
Please review the childcare sleep policy, provide your details, and acknowledge your understanding and consent.
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Legal Guardian
Grandparent
Other
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Does your child have any specific sleep needs or routines?
*
No, my child follows a typical sleep routine.
Yes, my child has specific sleep needs/routines (please describe below).
If you answered yes above, please describe your child's specific sleep needs or routines.
Does your child have any allergies, medical conditions, or medications that may affect their sleep?
*
No
Yes (please specify below)
If you answered yes above, please specify the allergies, medical conditions, or medications.
Childcare Sleep Policy
Additional comments or instructions for staff
Parent/Guardian Signature
*
Acknowledge and Submit
Acknowledge and Submit
Should be Empty: