Permission Signature Download The PDF Version Here! Child's Name * First Name Last Name Date of Entrance * MM DD YYYY Permissions * I hereby give Celia Riahi and members of her staff permission to administer basic first aid and /or CPR to my child, and /or to take my child to a hospital for medical treatment when I cannot be reached or when delay would be dangerous to my child’s health. I acknowledge that I have received a copy of the provider’s Parent Handbook on the Website, as well as information regarding lead poisoning prevention (may be included in the Parent Handbook). I understand that I may visit this family childcare home unannounced at any time during the hours that my child is in care My child will arrive to the program by Parent Drop-Off (if other, please explain below). My child will depart the program by Parent Drop-Off (if other, please explain below). If Your Child Will Arrive To The Program In A Way Other Than Parent Drop-Off, Please Explain Below If Your Child Will Depart The Program In A Way Other Than Parent Drop-Off, Please Explain Below Parent 1 Signature * Date Of Parent 1 Signature * MM DD YYYY Parent 2 Signature Date Of Parent 2 Signature MM DD YYYY Thank you so much for submitting the form!