Enrollment & Registration Instructions

1. Complete all sections of the Enrollment Form including:

   • Authorized Permission for Emergency Pick Up:
     Adults who may be contacted in an emergency when the parent/guardian cannot be reached and to with whom the child may be released. Emergency personnel will only release a child to someone on this list in an emergency. Per Connecticut State Law:
     • You must list at least one person who is not the child’s parent/guardian
     • Please give the first and last name of everyone on this list
   • Authorized Permission for Alternate Pick Up:
     Adults who are authorized to pick up the child. The Drop-In Center staff will only release your child to adults on this list. It is your responsibility to tell the staff at drop- off if there will be an alternate pick up and the name of the adult picking up. Adults authorized to pick up a child should be prepared to show their license at the time of pick up.

2. Complete, sign, & date the following:

   • Emergency Authorization (required)
   • Parent Information Packet & Behavior Management Policy Agreement (required)
   • Permission to attend special programs on campus (optional)
   • Photographic Consent & Release Preference Form (required)
   • Current Health Assessment Record (Use the checklist below to prepare your HAR)

Health Assessment Record Checklist

• HAR Part 1 – completed, signed, dated by parent/guardian
• HAR Part 2 – completed, signed, dated by physician (date of exam must be within the year and updated every year)
• HAR Immunization – updated immunizations
• Dental section is not required
• If your physician requires emergency medication at school/child care facility, additional paperwork is required.

Please send fully completed enrollment documents and Health Assessment Records that meet the criteria listed above to: Kellymccarthy@ccsu.edu