Creative Years Registration Form

Please note that the completion of this form DOES NOT guarantee a spot for your child(ren).


You will be contacted directly when we have an opening in any of the age appropriate programs.

You may either download the forms by clicking on the "Download Form" button or fill out the forms below and it will be automatically sent to Creative Years for review.

Facility License Number: 1056

Child Information

1st Child Information:

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2nd Child Information:

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3rd Child Information:

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Parent/Guardian Information

Parent/Guardian 1:

Parent/Guardian 2:

Emergency Contacts & Authorized Pickup Persons

1st Contact/Pick Up

2nd Contact/Pick Up

3rd Contact/Pick Up

4th Contact/Pick Up

Signature

(Typing your name will be taken as your electronic signature)

       Note to Parents

NOTE TO PARENT/S or GUARDIAN/S: The licensing authority for this program is the Bureau of Licensing and Certification, Child Care Licensing Unit. Child care programs are required to post a copy of the statement of findings and corrective action plan for the most recent visit in a location which is accessible to parents, and must maintain copies of the statement of findings and corrective action plan for the preceding visit and make them available for parents to review upon request. Statements of findings and corrective action plans are also available on-line at http://childcaresearch.dhhs.nh.gov or by calling the unit at 1-800-852- 3345, extension 9025 or 603-271-9025.

During visits to programs licensing staff speak with children regarding the care they receive at the program if in the judgment of the licensing staff the children's response would be valuable in determining compliance with licensing rules. Licensing staff are experienced in working with children and trained to speak with children in a manner that is respectful and non-leading. Children will remain with their class or group during these conversations with licensing staff, and at no time will a child be forced to speak with a licensing coordinator. If licensing staff believes your child may have specific information regarding an alleged event at the child care program, and determines that it is best to interview your child separately and not with their class or group, please indicate your preference among the following options:

For more information about Child Care Licensing please visit our website at:www.dhhs.state.nh.us/DHHS/BCCL/default.htm

Photography Policy

Throughout the school year we take photos and videos of the children to share with families on our website as well as social media channels that include YouTube, Facebook and Pinterest. To give us permission to take a photo or video of your child, please sign below.

Signature

(Typing your name will be taken as your electronic signature)

Emergency Medical Treatment Authorization

I hereby give permission for the staff of Creative Years to provide simple first aid treatment to my child(ren),
 

when necessary. In the event of a more serious illness or injury, I give permission for my child to be transported to a hospital or other emergency medical facility to receive emergency medical treatment. I also authorize ambulance/rescue squad attendants to administer such treatment as is medically necessary, and I authorize licensed health practitioners working in the hospital or emergency medical facility to examine and provide emergency medical treatment to my child if warranted. I understand that I will be contacted by a child care program personnel as soon as possible regarding any emergency involving my child.

Signature

(Typing your name will be taken as your electronic signature)

Annual Update

Parent/Guardian must review this information annually, make necessary changes and initial and date below to verify that the information is current.

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© Copyright 2019 by Creative Years Child Development & Learning Center

Contact Us

Tel: 603-880-7304

Email: info@creative-years.com

Address

30 Broad Street

Nashua, NH 03064