Licensed Out of School Time Care Program - New Mexico Kids

o The name and telephone number of two (2) people in the local area to contact inan emergency when the parent/s or guardian/s cannot be reached. Emergencycontact phone numbers must be kept up-to-date at all times.o The name and telephone number of the physician or emergency medical centerauthorized by the parent/s or guardian/s to contact in case of illness oremergency.o A form that is signed by the parent/s or guardian/s that gives the centerpermission to transport the child in a medical emergency and that authorizesmedical treatment for the child.o An agreement form which has been signed by the parent/s or guardian/s thatoutlines the services provided by the center and the costs of services.Section Two: Health information that includes:o A form that records any accidents, injuries or illnesses which require first aid or medicalattention. Documentation that these were reported to parent/s or guardian/s.o A form to record observation of recent bruises, bites or signs of potential abuse orneglect. Documentation that these were reported to Children, Youth and FamiliesDepartment.o Information regarding any allergies or medical conditions suffered by the child.o Authorization to administer medication formSection Three: Other forms/information that includes:o Attendance records that indicate the dates of attendance, times of arrival anddeparture. Attendance records shall be initialed by a parent/guardian or personauthorized to pick up the child. This record may be kept in another file. If so, pleaseindicate where attendance records are located.o A form that is signed by the parent/s or guardian/s which authorizes the center toremove the child from the premises to participate in off-site activities. The form mustinclude the field trip destination, date and time of the field trip and expected time ofreturn from the field trip.Section Four: Additional information required by the center: (for example, samples of child’swork, IEP/IFSP information, anecdotal notes of child’s participation in activities, developmentchecklists, etc.)Rev. 1-2-13 Page 19