Childcare Consent

I give permission for my child to participate in drop-in childcare at The Heights Ellis County Family Resources. I understand that all necessary precautions will be taken to ensure my child’s safety.

Liability Waiver:

I understand that The Heights Ellis County Family Resources and it’s staff are not responsible for any injuries or accidents that may occur while my child in in their care, provided that reasonable care and supervision are exercised.

Typing your first and last name below serves as your legal signature:

Parent/Guardian Liability Signature:

First Name

Last Name

Date Of Childcare

YYYY

Sign-In Time

Hour

Minute

Second

Sign-Out Time

Hour

Minute

Second

Child Name

First Name

Last Name

Age

Allergies

Child Name

First Name

Last Name

Age

Allergies

Child Name

First Name

Last Name

Age

Allergies

Child Name

First Name

Last Name

Age

Allergies

Parent/Guardian Signature

First Name

Last Name

Childcare Consent

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