PARENT/GUARDIAN INFORMATION: both must be provided, if applicable
***Please note: Both parents are assumed to have legal custody unless a court document is provided to the school that specifies otherwise.
Emergency contacts cannot be a mother or father. Two contacts must be provided. In an emergency situation, every effort will be made to contact parents/guardians. If they cannot be reached, list the following people who will be expected to assume responsibility for your children as emergency contacts and authorized pick up persons.
By signing below, I/We agree to the following:
In case of emergency, when I cannot be reached and the staff has concluded that medical help must be obtained, I hereby constitute and appoint Stonewood School North, LLC. and it’s staff my true and lawful attorney, only for the purpose of authorizing medical treatment, and the performance of any procedure determined to be necessary after consultation with the emergency physician of my child(ren). I agree to pay for all necessary transportation of my child(ren) to the nearest appropriate facility.
I understand that Vermont state statute requires that Stonewood School North report all suspected cases of child abuse or neglect.
I consent to allow the program director at Stonewood School North to access my child’s immunization records using the Vermont Immunization Registry.
I have read and understand the Stonewood School North Family Handbook (including all COVID-19 updates). I agree to follow all Stonewood School North procedures as outlined in the Family Handbook.
I authorize the childcare staff to apply non-prescription medications and products, ointments, creams, and other topically applied ointments and lotions provided by me, the parent/guardian (sunblock, diaper cream, lotion, etc).
I have read and understand the most recent guidance for COVID-19 and childcares from the Vermont Department of Children and Families, Vermont Agency of Education, and Vermont Department of Health. I/We agree to adhere to social distance guidelines as described by the Vermont Department of Health when out in public with our families. I/We will stay home if anyone in the family has symptoms of COVID-19 or have been tested for COVID-19, and I/We will report our symptoms and test results to the school director.I/We have filled out this Registration Form to the best of my/our knowledge and all information is current and correct. I understand that if any of the information on this form changes, I will update Stonewood School North immediately.