Child physical form

• [PDF File]CD 322 - Child Care Staff Health Assessment

  https://info.5y1.org/child-physical-form_1_0d0b86.html

  CHILD CARE STAFF HEALTH ASSESSMENT (55 Pa. Code §§3270.151, 3280.151 and 3290.151) NAME OF PERSON EXAMINED (Please print) REASON FOR EXAMINATION Initial employment in child care Biennial re-examination THIS SECTION TO BE COMPLETED BY EMPLOYER This physical examination is for the purpose of employment in a child care facility.

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• [PDF File]Child Health Report - Child Care Centers

  https://info.5y1.org/child-physical-form_1_94e344.html

  DEPARTMENT OF CHILDREN AND FAMILIES dcf.wisconsin.gov/ Division of Early Care and Education . CHILD HEALTH REPORT – CHILD CARE CENTERS . Use of form: Use of this form is voluntary; however, completion of this form meets the requirements of DCF 202.08(4), DCF 250.07(6)(L)3., and DCF 251.07(6)(k)3.

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• [PDF File]State of Illinois Certificate of Child Health Examination

  https://info.5y1.org/child-physical-form_1_b373d2.html

  Certificate of Child Health Examination Certificates of Religious Exemption to Immunizations or Physician Medical Statements of Medical Contraindication Are Reviewed and Maintained by the School Authority. Student’s Name . ... Yes PHYSICAL EDUCATION ...

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• ChiLD & ADOLEsCEnThEALT h ExAMinATiOn FORM Print Clearly

  RECOMMENDATIONS Full physical activity M Restrictions (specify) ... ChiLD & ADOLEsCEnThEALT h ExAMinATiOn FORM NYC DEPARTMENT OF HEALTH & MENTAL HYGIENE — DEPARTMENT OF EDUCATION Please Print Clearly NYC ID (OSIS) TO BE COMPLETED BY ThE PAREnT OR GUARDiAn

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• [PDF File]State of Illinois Certificate of Child Health Examination

  https://info.5y1.org/child-physical-form_1_4db9ed.html

  On the basis of the examination on this day, I approve this child’s participation in (If No or Modified please attach explanation.) Yes PHYSICAL EDUCATION No No Modified Modified INTERSCHOLASTIC SPORTS Yes

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• [PDF File]CHILD HEALTH REPORT - Pennsylvania Department of Human ...

  https://info.5y1.org/child-physical-form_1_f4cbdd.html

  I authorize the child care staff and my child’s health professional to communicate directly if needed to clarify information on this form about my child. PARENT’S SIGNATURE: Parents may write immunization dates; health professional should verify and complete all data. DO NOT OMIT ANY INFORMATION . This form may be updated by a health ...

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