6. Authorization and Permission Form for _______________________ (child’s name)
I/We _____________________________________________, hereby grant permission to Yasmeen Nasira and Alina Mendoza of
Alif-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 preschool program. ______
2. I/We hereby grant permission for our child to sleep in a nap room on a bed, mat or cot provided. ______
3. I/We hereby give permission for our child to leave the preschool premises under the supervision of a responsible
adult for neighborhood walks and other scheduled and unscheduled excursions. Permission forms for each trip are
not required. ______
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 preschool 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 to find alternate care for that 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. Parents will keep the provider informed of the foods being introduced. ______
8. I/We give permission to work on potty-training my child once they are determined ready for this process. I
understand that a child seat will be used on a regular toilet if needed. ______
11. Initialto InitialtoDeny I/We give permission for my child to participate in each of the following activities for
Approve no more than 2 hours each day. 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 Gamingsystems (EducationalOnly)
D Computer
I/We _______________________________________________, authorize Yasmeen Nasira and Alina Mendoza of
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 childcare provider 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.
______________________________________
Notary Public
My Commission Expires: _____________________________

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 provider cannot release my child to another person not listed.
Child’s name: ________________________________________ DOB: _________________________
The following persons are authorized to pick up my child:
1stPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
2ndPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
3rdPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
4thPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
5thPerson
Name: Relationship:
Address: Work/Home Phone:
City/Zip: AlternateContact:
_________________________________ _______________________________
Parent/Guardian signature Date
_________________________________ _______________________________
Parent/Guardian signature Date

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:
(Pleasecheckone)
Type of Use:
GrantPermission Decline Permission
StillPhotographs:
Display in preschool’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 preschool 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 MY PRESCHOOL PROVIDER 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_________
PROVIDER SIGNATURE
______________________________________ Date_________