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Daycare Medical Form Template

Streamline Medical Record Collection for Your Daycare

Are you struggling to gather important medical information from parents for your daycare? This daycare medical form template helps you collect essential health records and details efficiently, ensuring that you have all the necessary information on hand. With this template, you can simplify the onboarding process, maintain secure submissions, and enhance communication with parents, while also meeting compliance standards like HIPAA. Experience how easy it is to get started by trying out the live template today.

Use this Template (FREE) Live Preview
Child full name
Date of birth
Home address
Gender
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
Primary parent/guardian full name
Primary phone number
Primary email address
Relationship to child
Mother
Father
Legal guardian
Grandparent
Other
Please Specify:
Emergency contact full name
Relationship to child (emergency contact)
Emergency contact phone number
Primary care physician full name
Physician phone number
Preferred hospital or clinic
Health insurance provider and policy number
List any known allergies and reactions
List current medications and dosing schedule
List any chronic conditions or special diagnoses
List hospitalizations or surgeries in the past 12 months (include dates)
Does the child have a prescribed epinephrine auto-injector?
Yes
No
Date of last tetanus shot
Are immunizations up to date per schedule?
Yes
No
In progress
Unsure
Authorize basic first aid by trained staff
Yes
No
Authorize emergency medical treatment and transport if a parent/guardian cannot be reached
Yes
No
Over-the-counter items you authorize when needed according to label and center policy (select all that apply)
Authorize staff to administer the child's prescribed epinephrine auto-injector in an emergency
Yes
No
Parent/guardian printed name
Date
I certify the information provided is accurate and I am authorized to provide consent for this child
Yes
No
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Paper art illustration featuring a daycare medical form with colorful designs and icons related to health and childcare

When to use this form

Use this medical form when you enroll a child, update health records, or plan off-site activities. It gives your team the allergy, medication, condition, provider, and consent details needed to act fast in an emergency and provide daily care. During enrollment, pair it with the Childcare center pre-registration form. If a child has known sensitivities, collect specifics with the Daycare allergy form. For daily roll call and ratios, note any care alerts alongside your Daycare attendance form. The result is fewer delays, clearer instructions for staff, and safer care for every child.

Must Ask Daycare Medical Questions

  1. What is the child's full name and date of birth?

    These identifiers reduce mix-ups on medication logs, labels, and incident reports. If you also use the Preschool registration form, this keeps medical details tied to the same child record.

  2. Which allergies or sensitivities does the child have, and what are the reactions and treatments?

    Capturing triggers, reaction types, and required steps helps staff act quickly and correctly. It also signals when an EpiPen or antihistamine must be on site and who can administer it.

  3. What medications are used in care, with dosage, timing, and storage needs?

    Clear instructions prevent missed doses and dosing errors during busy drop-off and pick-up times. Written permission and storage notes (refrigeration or locked cabinet) keep your program compliant.

  4. What ongoing conditions or care plans should we follow (asthma, seizures, diabetes)?

    Documenting conditions and an action plan tells staff what to watch for and how to respond. Ask families to share doctor-signed plans so you have precise steps and thresholds.

  5. Who are the emergency contacts and healthcare providers, and do you grant consent for emergency treatment?

    Listing guardian and provider contacts, plus consent to treat, removes delays when minutes matter. Keep those contacts aligned with your Sign in sheet form so the right people get a call fast.

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