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Petits Poussins Brooklyn

Petits Poussins Brooklyn, 11 Hoyt Street Frederick, Brooklyn NY 11201

APPLICATION: ONE-TIME FAMILY FEE: $200.00

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Guardian 1

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Guardian 2

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September - June




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Medical Statements and Consent

Petits Poussins Brooklyn is not permitted to administer any medication, if needed, please do so at home or after school.

I (we) authorize staff and Director of Petits Poussins Brooklyn to obtain all necessary Emergency Medical treatment, in case of an emergency.

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Note: All allergies/medical conditions must be stated on the child's medical form. Additionally, a "Standing Order" from the Pediatrician will be required in order to administer an Epi-Pen, Benadryl, or any Asthma medication. Your child will not be admitted without it.

New York department of health requires that all children are vaccinated for school entrance.

I, hereby, authorize Petits Poussins Brooklyn to provide care for my child.

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I declare to the best of my knowledge that all statements made in this application are true.

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