Parent Forms

Enclosed you will find the items from this list that are checked off.  Please return the forms on your scheduled home visit day or on the first day that your child attends the program.  (“current Physical Examination/Immunization Documentation is needed prior to the first day)

  • EBJ Parent Handbook (Please sign signature page for our files)
  • EBJ Board of Directors ListWill be emailed separately. 
  • Year’s Calendar - check the “update” date for there may be additions to it as the year goes on
  • Emergency Contact & Long Term Pick up Authorization Form - You will provide a list of names of people other than you who would be available to pick up your child.   One name must be an EBJ parent.  The form must be current within one year.  returning families can update by adding a current date and initialing if all information is the same.
  • Non-Prescription Topical Medication Form - Diaper creams and skin lotions must be in their original containers and labeled with the child’s name.   EBJ staff cannot apply the cream/lotion without this form.
  • Permission Form for photographs, walking, data collection and outside observationThese are all part of EBJ’s curriculum and mission.   You are signing that you are aware of this. Please bring questions to my attention if you have them.
  • Permission to Share Medical Records Form - This will give permission for EBJ (specifically our nurse) to secure information on your child’s behalf regarding his/her physical examination document, individual health care needs documention, and prescription information as/if needed.
  •  State of Connecticut Health Assessment Form- This form must always be current within one year and updated with each new immunization that your child receives.  The first page is crucial - it is the parent input page and needs to be filled out annually.  Our nurse will send reminders when immunizations and new physical exam information is required.   This form might be substituted with your doctor’s office’s electronic forms, but it’s good to have this form on hand.
  • Your Child’s Classroom’s Daily Schedule -


                                   Sea Turtles(12mos.-24mos.)


                                  Butterflies (36mos.-60mos.)

  • Your Child’s Class List  - Will be emailed separately.