Old Bridge Before & After School Day Care Program
PARENTS DOCUMENT & PERSONAL INFORMATION

Dear Parent:

In keeping with New Jersey's child care center licensing requirements, we are obligated to provide you, as the parent of a child enrolled in our program, with this informational statement. The statement highlights, among other things, your right to visit and observe our center's at any time without having to secure prior permission; the center's obligation to be licensed and comply with licensing standards; and the obligation of all citizens to report suspected child abuse, neglect, exploitation to the State's Division of Youth and Family Services (DYFS). Please read this statement carefully and if you have any questions, feel free to contact us at (732) 721-5600 ext. 2395 or 2390.

Sincerely,
Before/After School Program

Name of Child
Name of Parent

I have read and received a copy of the Information to Parents Statement prepared by the Bureau of Licensing in the Division of Youth and Family Services.

Signature                     Date

Personal Information

Name of Child

As a parent/guardian of the above participating child, I certify that he/she is in good physical health, has no special needs, and may participate in all the activities of the Center's program except as noted.

Parent/Guardian Signature        Date

Home Phone      Business Phone

Insurance Company            ID #

Group #

My child requires the following special needs: