Student Ministries Info

Parents Names:  1_________________     2_____________________
Work Phone #:  ___________________
Cell Phone #  ____________________
Children's Names, Ages, Blood type, and Allergies:
1___________________________________________________________   
2___________________________________________________________ 
3___________________________________________________________
4___________________________________________________________

EMERGENCY PHONE NUMBERS
Family Member __________________  Phone # _______________
Doctor _________________________ Phone # _______________
Poison Control #  _________________
Preferred Hospital ___________________ Phone #  __________________

MEDICAL CONSENT FORM
I (we) authorize representatives of Franklin Christian Church to seek necessary and appropriate medical care for my (our) children under the supervision of a physician licensed to practice medicine in the State of Tennessee. I (we) assume full financial responsibility for medical care provided.  Please contact me (us) as soon as possible after my child is brought in for treatment.

Signature  __________________________ Date  _____________

Signature ___________________________ Date _____________

BEDTIME
What is Bedtime?
How Long is Naptime?
Does the child use a pacifier?
Does the child have a special doll, teddy bear, blanket or toy for sleeping?

Door Shut or open?
Light on or off?
Bedtime Snack?
Is the child afriad of the dark/thunder/monsters?
How are fears consoled?
Do I need to awaken the child to take him to the toilet?   How often?

Are there any prayers, blessings or other bedtime traditions that should be said at bedtime?
 

BOTTLE FEEDING AND INFANT FOODS
What does the baby take in his/her bottle?  (milk, formula, juice, diluted juice....)

How is the bottle prepared and served?

How often do they need the bottle?

Any solid foods yet?

BATHING
When should they bath?

Do Children Bath together?

Where are the bathing supplies (towels, soap, shampoo)?

How long does bathtime usually last?

Does the child prefer privacy?  Do they lock the door?

How can the bathroom door be unlocked from the outside?
 

TOILET TRAINING/DIAPERING
Is the child toilet trained?

Where are the diapers?

Do you use lotion or powder?

MEALTIME
When is meal time?  Breakfast______  Lunch ________ Dinner ___________
Are there special dishes, spoons, bibs...?

Does the child feed himself/herself?

Is there anything the child should NOT eat?

Are there any food allergies?  If yes what reactions should I watch for and what should I do if a reaction occurs?
 

May the child watch TV while eating?
 

SNACK TIMES
When?

What?

Is there anything that should not be eaten for snacks?

Where may the snacks be eaten?

HOUSE RULES
May we watch TV (Videos)?  When?  Where?  What programs are ok?  Can the Child turn on the TV by themselves?
 

What are the Indoor Play area limits?  Some favorite toys, games or activities?
Are there old clothes for messy play?
 

Are children allowed to run and roughhouse inside?

Are friends allowed over?  Who?  Inside or outside?

May your children go to a friends house?  If so please list names and phone numbers.
 

May the children use the phone?
 

How are arguments or disagreements usually handled?

What Disciplinary action do you prefer?  (time out, No TV, Go to room - We ask our sitters not to spank)
 

Where can the children play outside?

Any special rules for outside?  Favorite activities?

If insect bites are a problem how should they be treated?

LOCATION OF HOUSE HOLD ITEMS
First Aid supplies:
Flashlight:
Extra House Key:
Bathroom Key:
Circuit Breakers/fuse/fuse box:
Fire Extinguiser:
Vacuum/broom /mop:
Candles and matches:
Thermometer:
Pain and Fever Reliever:
Ipecac Syrup (for poisoning):
Medicine cup or spoon:
Other: