Childcare Intake Form

Client Full Name

Child/Children Names and Date of Birth

Example:

Leo (1/24/18)

Jensen (2/22/20)

Ronny (3/1/22)

I am the legal guardian of the child/children listed above. I am authorized by the legal guardians to act as caretaker.

Yes

Please list Parent or Legal Guardian's Name and Phone Number.

Allergies or Medical Conerns

No food or medications will be given by our childcare team.

Emergency Contact/Phone Number

If parent or guardian cannot be reached

Permissions

I give permission for my child(ren) to participate in supervised activities within the childcare area.
For staff to apply basic first aid (bandages, ice pack, etc.) if necessary.
I understand that staff will not administer medication or food.
I understand that I must remain on-site at all times while my child(ren) are in care.

Liability Waiver & Acknowledgment

I, the undersigned parent/guardian, understand that childcare services provided by The Nest Beauty Services are intended for short-term, on-site care only while I remain on the premises.

I acknowledge and accept that:

The Nest Beauty Services and its employees are not liable for accidents, injuries, or illnesses that may occur while my child(ren) are in care, except in cases of proven negligence.
I agree to follow all childcare and safety policies.
I release and hold harmless The Nest Beauty Services, its owners, and staff from any and all liability or claims arising from participation in this childcare program.

By checking this box, I am providing my electronic consent and agreement in place of a handwritten signature.

Childcare Intake Form

The Nest Beauty Services

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