Fillable Childrens Waiting Room Policies and Parent/Guardian Agreement Form (Superior Court of California)

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Childrens Waiting Room Policies and Parent/Guardian Agreement Form (Superior Court of California)

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Children’s Waiting Room Policies and Parent/Guardian Agreement Form
Welcome to the Children’s Waiting Room
1. Arrival: We offer quality early learning experiences for you child while you conduct court business. Please feel welcome to spend
up to 10 minutes to help your child feel comfortable in The Children’s Waiting Room. We ask that you leave after 10 minutes so
that we can start our busy day. When you and your child arrive you will be asked to:
Complete an emergency information form
Sign the daily attendance list
Check in with a teacher so she can help your child when you depart
If an emergency evacuation is required while your child is in care they will not be released to the adult until the building is
cleared and children return to the Children’s Waiting Room. All Adults must follow the public evacuation process as designated
by the courthouse.
2. Participation: Please be aware that by participating in this program you must remain in the building while your child is in the
Children’s Waiting Room.
3. Food: Children will be given a healthy snack. If your child has food allergies or is on a restricted diet, discuss the snacks with the
teacher to be sure they are safe. We close during the lunch hour from 12:00 pm to 1:15 pm. Lunch is not provided, so please plan to
pick up your child before 11:45 am. The Children’s Waiting room closes at 4:30 pm; all children should be picked up by 4:15pm.
We will make every effort to accommodate for late pickup if there is extenuating circumstances. We ask that you contact the child
care room directly if such an event occurs.
5. Health: All children need to be healthy to use the Children’s Waiting Room. If your child shows symptoms of fever, breathing
difficulties, severe cough, diarrhea, vomiting, sore throat, infections of the skin or eyes; or lice they can not be cared for in the
Children’s Waiting Room. If your child becomes sick while in care, a teacher will contact you to pick them up immediately.
6. Behavior Issues: The Children’s Waiting Room policies have been developed with the safety of children in mind, if your child
poses a threat to him/herself or others or is behaving in an inappropriate manner, you will be contacted to pick your child up
immediately. Behavior issues may limit your future use of the Children’s Waiting Room.
7. Pick up: Only the parent/guardian dropping the child off will be permitted to pick up the child. We ask that you limit your time
in the Children’s Waiting Room to no more than 10 minutes after pick-up.
I have read, understand and agree to each of the parent/guardian policies set forth in this document, and agree to hold harmless
Choices for Children, CDI/ CDC and the Superior Court of California, San Bernardino County, its agents, officers, and employees,
from and against any and all claims, losses, liabilities or damages, including payment of attorney’s fees arising or resulting from the
performance of this Agreement.
Parent/Guardian Signature:
Date:
Choices for Children staff
Date:
Superior Court of California, San Bernardino
Children’s Waiting Room Pre-Registration Form
Parent/Guardian :
Relationship:
Mailing Address:
Phone:
Child’s First/Last Name:
Birth date:
Does the child have allergies we should be aware of?
yes no (if yes, please explain)
Does the child have medical conditions we should be aware of?
yes no (if yes, please explain)
Are there custody issues/agreements we should be aware of?
yes no (if yes, please explain)
IN CASE OF AN EMERGENCY, OR IF I CANNOT PICK-UP MY CHILD, I HERBY AUTHORIZE THE FOLLOWING PERSON(S) TO PICK-
UP MY CHILD
Name:
Phone:
Relationship:
Mother Father Grandparent Legal Guardian Other
Name:
Phone:
Relationship:
Mother Father Grandparent Legal Guardian Other
IN CASE OF INJURY OR SUDDEN ILLNESS, I HERBY GIVE AUTHORITY TO ANY HOSPITAL OR DOCTOR TO RENDER IMMEDIATE
AID AS MIGHT BE REQUIRED. IT IS UNDERSTOOD THAT I WILL ACCEPT THE EXPENSE OF THIS SERVICE.
Parent/Guardian Signature:
Date:
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Childrens Waiting Room Policies and ParentGuardian Agreement Form (Superior Court of California)

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Completed 29 July 2020

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