This document provides an authorization and permission form for a child named [CHILD'S NAME] to attend Alif-Ba-Ta Learning Center. It allows the child to participate in indoor/outdoor activities, sleep with provided bedding, go on walks and excursions supervised by staff, and attend field trips with advance permission. Parents give permission for sunscreen use, over-the-counter medication, and media access. Emergency medical authorization and child release are also provided. Photograph and transportation permissions are granted for promotional materials and field trips.

6. Authorization and Permission Form for _______________________ (child’s name)
I/We _____________________________________________, hereby grant permission to staff atAlif-Ba-Ta Learning Center to
provide the following activities for our child by initialing & signing below.
1. I/We hereby grant permission for our child to use all of the indoor and outdoor play equipment and to participate in
all of the activities of this program. ______
2. I/We hereby grant permission for our child to sleep in a mat or cot provided. ______
3. I/We hereby give permission for our child to leave the premises under the supervision of a responsible adult for
preschool walks and other scheduled and unscheduled excursions. Permission forms for each will be provided.
______
4. I/We understand that all field trip expenses are the parent’s responsibility and agree to this as it is stated in the policy
statement of this program. I/We also understand that if a field trip will take place that the staff will give advance
notice and a separate permission form to be signed with the details of the trip. I also understand that if I choose for
my child not to attend, that it is my responsibility keep the child out of the program for the day without tuition
reimbursement from the center for the fieldtrip. ______
5. I/We give permission for our child to have sunscreen applied on exposed skin areas before going outside on sunny
days. Sunscreen is supplied by the parent/staff and applied per stated in the health policies handbook. ______
6. I/We give permission for over the counter products and topical to be used on our child for preventative purposes
including but not limited to skin lotion, diaper cream/ointments, Orajel, Neosporin, Chapstick, or ___________ and
______________.
7. Initialto
Approve
InitialtoDeny I/We give permission for my child to participate in each of the following activities. All
media programs contain age-appropriate content (G or PG ratings) and will not contain
violence, profanity or other inappropriate content.
A Television
B Video
C Gaming systems (Educational Only)
D Computer
NOTORIZED AUTHORIZATION FOREMERGENCY MEDICAL CARE
I/We _______________________________________________, authorize staff at Alif-Ba-Ta Learning Center to call a doctor,
911, or an ambulance for medical or surgical care for my/our child __________________________________ (child’s name),
should an emergency arise. It is understood that a conscientious effort will be made to locate the parents/guardians before
emergency action will be taken, but if this is not possible, the expenses of emergency medical treatment or care will be
accepted by the parents/guardians. Notarization is required annually to provide the program staff with authorization to give
medical authorization to emergency/health professionals:
_______________________________________ _____________________
Parent/Guardian Date
_______________________________________ _____________________
Parent/Guardian Date
Subscribed and affirmed before me this ____________ day of ___________, 20__, in the County of
__________________________, State of Colorado.
______________________________________ My Commission Expires: _____________________________
Notary Public

7. Child Release Authorization
I understand that every effort will be made to contact me. In the event the staff is unable to reach me I authorize the
following designate(s) to pick up my child. I understand designate(s) must be over the age of 18 years and have a
valid state issued driver’s license and an age appropriate vehicle child restraint. I will instruct my designate(s) to
bring their I.D. with them each time they are needed to pick up my child. I also understand that any additions to my
Child Release form must be done in writing prior to needing a new addition to pick my child up. I understand
without written consent the staff cannot release my child to another person not listed.
Child’s name: ________________________________________ DOB: _________________________
The following persons are authorized to pick up my child:
1st
Person
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
2nd
Person
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
3rd
Person
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
4th
Person
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
5th
Person
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
_________________________________ _______________________________
Parent/Guardian signature Date
_________________________________ _______________________________
Parent/Guardian signature Dat

8. PERMISSION TO PHOTOGRAPH FORM
I, ________________________________________________________________________________________
(parent’s or guardian’s name)
give permission for Alif-Ba-Ta Learning Center
to photograph my child/ren, _____________________________________________________________
(child’sname)
for the following purposes:
Type of Use:
(Pleasecheckone)
GrantPermission Decline Permission
StillPhotographs:
Display in program’s scrapbook or
bulletin boards, shown to current and
prospective families
Display still photos on center’s website *
Use still photos in promotional materials
Videos:
Display video on facility website
Use videos in promotional materials
Other (pleaselist):
* only first names and possibly last initials (in the event of two or more children with the same first
name) will be displayed on the facility website.
I understand that it is my responsibility to update this form in the event that I no longer wish to
authorize one or more of the above uses. I agree that this form will remain in effect during the
term of my child’s enrollment. By signing below, I also agree that this is a legally binding form,
and providing false information could be grounds for termination of the program’s services,
forfeiture of retainer, or both.
Father/Guardian’sSignature Date
Mother/Guardian’sSignature Date
Alif-Ba-Ta Learning Center Date

9. P
PERMISSION TO TRANSPORT AND FIELDTRIPS
I HEREBY GRANT ALIF-BA-TA LEARNING CENTER PERMISSION TO TRANSPORT MY CHILD IN
LICENSED INSURED VEHICLES, USING FEDERAL APPROVED CHILD SAFETY SEATS AND BELTS
ACCORDING TO FEDERAL LAWS.
I UNDERSTAND THAT MY CHILD IS BEING TRANSPORTED FOR THE FOLLOWING REASON(S):
Field trips and emergency purposes.
IF A FIELD TRIP IS SCHEDULED, I UNDERSTAND THAT I WILL BE GIVEN A SEPARATE FORM THAT
WILL NEED TO BE SIGNED WITH THE DETAILS OF THE FIELDTRIP, INCLUDING: DATE, TIME,
LOCATION, AND COST.
PARENTS SIGNATURE
______________________________________ Date_________
PROGRAM STAFF SIGNATURE
______________________________________ Date_________

10. Program Transportation Release
____ Check if Non Applicable to this child
Child’s Name: ___________________________________________________________________
Days Transportation Needed: M T W R F
School Pick Up Time: ______________ School Drop Off Time: ______________
I/we _____________________________________ have requested Alif-Ba-Ta Learning Center to transport
my child to the educational program.
I/we understand it is my responsibility as the parent, to notify Alif-Ba-Ta Learning Center in advance and
in writing of any changes in the need for transportation.
I/we understand that if there is ever an issue with the program staff not being able to transport my child,
that I will be given as much notice as possible, and it will become my responsibility to get my child to the
center on those days.
I/we understand that is my responsibility as a parent, to notify Alif-Ba-Ta Learning Center immediately in
the event that my child will not be riding to the center due to an illness/or otherwise.
I/we, the undersigned parent(s)/guardian(s), do understand that center transportation is provided as a special
service.
I/we will not hold Alif-Ba-Ta Learning Center responsible for any problem that may arise due to weather,
mechanical problems with the center vehicle, scheduling conflicts, etc.
__________________________________ ___________________________________
Parent/Guardian Parent/Guardian
__________________________________ ___________________________________
Date Date