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Records release Request
713 Pierce Road
Clifton Park, NY 12065
(518) 3731181 fax: (518) 3730130
WWW.SMILELODGE.COM
Patients Name (please print): ___
Date of Birth: ___
Description of records you wish
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How to fill out child care authorization
How to fill out child care authorization
01
Obtain a child care authorization form from the child's parent or guardian.
02
Fill out the child's information such as name, date of birth, and any medical conditions.
03
Include the parent or guardian's contact information and emergency contact information.
04
Specify the dates and times that the child care authorization is valid for.
05
Sign and date the form to indicate your agreement to provide child care.
06
Make copies of the completed form for your records and provide a copy to the parent or guardian.
Who needs child care authorization?
01
Anyone who is responsible for caring for a child in the absence of the parent or guardian may need child care authorization.
02
This could include babysitters, family members, or friends who are watching the child for a period of time.
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What is child care authorization?
Child care authorization is a legal document that grants permission for someone to care for a child in the absence of their parent or legal guardian.
Who is required to file child care authorization?
Parents or legal guardians are required to file child care authorization if they need someone else to care for their child in their absence.
How to fill out child care authorization?
Child care authorization can be filled out by providing information about the child, the caregiver, and the duration of care needed.
What is the purpose of child care authorization?
The purpose of child care authorization is to ensure that children are safe and cared for by authorized individuals in the absence of their parents or legal guardians.
What information must be reported on child care authorization?
Information such as the child's name, caregiver's name, contact information, duration of care needed, and any special instructions must be reported on child care authorization.
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