| Injury/Accident Report
Child's Name: ____________________________________ Age: _____ Date: _____________ Class: __________ Teacher(s): ______________________ Time of Accident: _____________ List Adults Present _________________________________ Number of Children ___________ Description of Accident: _________________________________________________________ ____________________________________________________ First Aid given: ________________________________________________________________ Administered by: _______________________________________________________________ (Circle all that apply) Location Bathroom Playground Stairway Hallway Preschool room Toddler room Infant room School-Age room Walkway Markings Abrasion Bump Red Mark Sprain (suspected) Bite Cut/Tear Rug Burn Other _________ Bruise Fracture (suspected) Scratch Appendage Left Buttock Eye Heel Neck Teeth Right Cheek Finger Hip Nose Toe Ankle Chin Forehead Knee Penis Tongue Arm Ear Hand Leg Shoulder Vagina Back Elbow Head Lips Stomach Wrist Notification 911 Called Time: __________ Transportation Used Type Parent Called Time: ________ Ambulance Reached By Whom ____________ Message Left Hospital/Clinic ____________ Physician Called Time: _______ If serious injury/death, notify the Licensor. Teacher's Signature: ___________________________________ Date: __________________ Director's Signature: __________________________________ Date: __________________ Parent's Signature: ____________________________________ Date: __________________ |
| Notice of Pet�s on premises at
Kelly's Kiddy Kare Children�s names Birth dates This is to confirm that the under signed parent or guardian of the above children has been notified of the following pets on the premises and may have occasional access to the children while in this childcare home/facility. Mother Date Father Date Provider Date Bud- Is a male pembroke welsh corgi (fixed). He is very well behaved and socializes well with children. He loves to be around children and can get just excited as they get. Bubbles ~ Is a male kitten (fixed). He is the most gentlest cat that I have ever seen. He loves the attention and to be given treats ;) Tink ~ Is a female kitten. (getting fixed). She was a stray at a young age and we adopted her through the Women's Humane Society and we are working on socializing her with the kids. She play's well with other animals so I see this as not being an issue. Cami ~ Is our daycare mascot. She is a cockateil. Loves to sing and flap her wings for the kids! All animals receive their annual vaccinations through a licensed Veterinarian. |
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