Oral Opt-Out Form

In January 2010, EEC issued new regulations for child care programs that include a requirement that educators assist children with brushing their teeth if children are in care for more than four hours or if children have a meal while in care [606 CMR 7.11(11)(d)]. This regulation is intended to:

Help children learn about the importance of good oral health

Provide information and resources regarding good oral health to child care programs and families

Help address the high incidence of tooth decay among young children in Massachusetts, which is associated with numerous health risks.

EEC licensed programs must comply with this regulation. However, parents may choose that their child (ren) not participate in tooth brushing while present at the child care program.

You do not need to fill out this form to have your child(ren) participate in tooth brushing while they are in child care. However, if you do not want your child to brush his or her teeth while s/he is attending the child care program, please fill out the information found below. A separate form must be filled out for each child in care. This form must be renewed annually and will be kept in your child’s record at the program. Should you change your mind and wish for your child to participate in tooth brushing, this form may be withdrawn at any time by requesting in writing that it be removed from your child’s file. Thank you.

Child's Name

First Name

Last Name

Parent's or Guardian's Name

First Name

Last Name

Parent or Guardian's Signature

Date

MM

DD

YYYY

I do not wish to have my child participate in tooth brushing while in care at THE COTTAGE GARDEN

If you have any questions or concerns, click here.

Oral Opt-Out Form

The Cottage Garden // Celia Riahi