Childcare Check-In/Check-Out Log
Please complete this log for each child's arrival and departure at the facility.
Child's Full Name
*
First Name
Last Name
Date of Check-In/Check-Out
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Check-In Time
*
Hour Minutes
AM
PM
AM/PM Option
Check-Out Time
Hour Minutes
AM
PM
AM/PM Option
Authorized Adult's Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Parent
Guardian
Relative
Babysitter/Nanny
Other
Authorized Adult's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Check-In/Check-Out Status
*
Check-In
Check-Out
Signature of Authorized Adult
*
Notes or Special Instructions
Submit Log
Submit Log
Should be Empty: