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Story Book Forms

Select the form needed to complete


Form to administer medication

The attached form must be filled out before we can administer any medication. Caregivers should fill out the top portion and the authorization near the bottom. The prescribing physician must sign in the box labeled "For Prescription Medication". If a doctor's signature is not on the form we will not be able to administer the medication until it is signed. Your child's medication will be stored in a secure lock box.


Form to notify Director

Full-time child care children are given an allotted amount of vacation days. In order to use, this form must be submitted to the Director prior to vacation to adjust billing.

Diet Modification

Form to notify of allowed substitutions

This should be completed for any food restrictions. This form should be completed and signed by a "medical authority".

Food/Allergy Action Plan

Form for emergency action

If your child has documented allergies or an epi pen, this form should be completed by a "medical authority".

Asthma Action Plan

Form to complete if your child has asthma

If your child has asthma, this form should be completed by a "medical authority".

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