date when new Enter date when Enter date when Enter date when Policy Change Notice was stapled to the current Emergency verbal contact was Policy Change Safe Arrival & Departure Agreement and Emergency Treatment Treatment and made with Notice was and Consent Form to reflect the change. Note: If parent requests Consent Form is Child’s Name Parent/Guardian parent/guardian returned to add other authorized adults, you must start a new form. uploaded into C+ (keep original in file)
Child’s Name Parent/Guardian Enter date when verbal contact was made with parent/guardian Enter date when Policy Change Notice was returned Enter date when Policy Change Notice was stapled to the current Safe Arrival & Departure Agreement and Emergency Treatment and Consent Form to reflect the change. Note: If parent requests to add other authorized adults, you must start a new form. date when new Emergency Treatment and Consent Form is uploaded into C+ (keep original in file)
ATTACH_Tracking_Form_HAVE_NOT_Authorized_Safe_Arrival_Departure_due_after_Fall_Home_Visits_15OCT2018.docx