Edit, Download, and Sign the DPHHS CCL 113 Emergency Contact Consent Form
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How do I fill this out?
To fill out this form, begin by entering the child's name and date of birth. Next, provide detailed allergy information and emergency contacts. Ensure all sections are completed accurately for effective communication.
How to fill out the DPHHS CCL 113 Emergency Contact Consent Form?
1
Enter the child's name and date of birth.
2
List any allergies and necessary medical information.
3
Provide parent or guardian contact details.
4
Fill out emergency contact information.
5
Sign and date the form to authorize permissions.
Who needs the DPHHS CCL 113 Emergency Contact Consent Form?
1
Parents or guardians who want to ensure their child’s safety while in childcare.
2
Childcare providers who need to maintain accurate emergency contact info.
3
Schools that require updated medical information for enrolled children.
4
Emergency services personnel who may need immediate access to critical child information.
5
Relatives or caregivers involved in the child's welfare.
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What are the instructions for submitting this form?
After completing the DPHHS CCL 113 form, submit it to your childcare provider via email or by fax to the number provided on the form. Physical submissions can be made directly at the childcare center. For online submissions, check with your childcare provider for specific instructions.
What are the important dates for this form in 2024 and 2025?
Ensure to review and submit updated information each year before the start of the school year. Review deadlines for emergency contacts may vary by facility. Make a note to check any specific requirements as they may change.
What is the purpose of this form?
The purpose of this form is to ensure the safety and well-being of children while in the care of childcare providers. It establishes a protocol for emergency situations by providing vital contact and medical information. By completing this form, guardians grant permission for necessary medical treatment in emergencies.
Tell me about this form and its components and fields line-by-line.
- 1. Child's Name: Fields for entering the first and last name of the child.
- 2. Date of Birth: Field for entering the child's birth date.
- 3. Allergy Alert: Section for indicating if the child has any allergies.
- 4. Parent/Guardian Contact: Details for parent or guardian contact information.
- 5. Emergency Contact Information: Fields for listing persons other than parents who can pick up the child.
- 6. Medical Information: Section to enter primary medical care provider details and health concerns.
- 7. Parent/Guardian Authorization: Signature area for parent or guardian consent for medical treatment.
What happens if I fail to submit this form?
Failure to submit this form may lead to delays in emergency response for your child. It is crucial that all information is provided accurately to avoid miscommunication in emergencies.
- Inadequate Emergency Preparedness: If the form is not submitted, staff may not have vital information necessary to respond appropriately.
- Communication Gaps: Not having accurate contact details may lead to difficulties in reaching guardians.
- Health Risks: Failure to disclose allergies or health concerns could place the child at risk.
How do I know when to use this form?
- 1. Enrollment in Childcare: Required for initial enrollment in any childcare setting.
- 2. Annual Updates: Necessary to update emergency contacts and medical information yearly.
- 3. At the Start of School Year: Should be submitted before the start of a new school term.
Frequently Asked Question
What is the purpose of this form?
This form provides essential emergency contact and medical information for children in childcare.
How can I edit this PDF?
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Is there a way to share this form?
Yes, PrintFriendly allows you to easily share your PDFs through email or links.
What steps do I take to fill out this form?
Fill in child information, allergies, and emergency contacts, then sign and date.
How do I provide consent?
Sign the form to authorize medical treatment in case of emergencies.
Can I save my changes to the PDF?
You can download your edited PDF after making changes.
Do you offer support for editing?
Yes, PrintFriendly provides comprehensive tools for seamless editing.
Is this form required annually?
Yes, it must be completed and signed every year.
Where can I find more forms like this?
You can browse our website for additional childcare-related forms.
What should I do if I have questions about the form?
Contact your childcare provider for assistance regarding this form.
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