Form CFS593 "Consents to Day Care Providers" - Illinois

What Is Form CFS593?

This is a legal form that was released by the Illinois Department of Children and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2007;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CFS593 by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS593 "Consents to Day Care Providers" - Illinois

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CFS 593
Rev 7/2007
State of Illinois
Department of Children and Family Services
CONSENTS TO DAY CARE PROVIDERS
NAME OF CHILD
THESE CONSENTS ARE FOR NON-DCFS WARDS ONLY AND MAY ONLY BE USED FOR DAY CARE SERVICES.
Parent(s) or legal guardian placing the child may sign any or all of the following consents:
EMERGENCY MEDICAL CARE
This authorizes
to secure EMERGENCY medical care for my/our child when I/we cannot be immediately reached at the time of emergency. I/we will
be responsible for the emergency medical charges upon receipt of the statement.
is the preferred doctor/clinic/hospital.
Date
Signature of parent/guardian
Relationship to child
Date
Signature of parent/guardian
Relationship to child
ADMINISTER PRESCRIPTION MEDICINE
I/we authorize
to administer prescribed medicine to my/our child as
specified in the prescription’s directions for administration.
Date
Signature of parent/guardian
Relationship to child
Date
Signature of parent/guardian
Relationship to child
ADMINISTER OVER-THE-COUNTER MEDICINE
(Administer only in accord with the appropriate standards for licensure)
I/we authorize
to administer over-the-counter medicine to my/our
child as specified in written instructions.
Date
Signature of parent/guardian
Relationship to child
Date
Signature of parent/guardian
Relationship to child
- over -
CFS 593
Rev 7/2007
State of Illinois
Department of Children and Family Services
CONSENTS TO DAY CARE PROVIDERS
NAME OF CHILD
THESE CONSENTS ARE FOR NON-DCFS WARDS ONLY AND MAY ONLY BE USED FOR DAY CARE SERVICES.
Parent(s) or legal guardian placing the child may sign any or all of the following consents:
EMERGENCY MEDICAL CARE
This authorizes
to secure EMERGENCY medical care for my/our child when I/we cannot be immediately reached at the time of emergency. I/we will
be responsible for the emergency medical charges upon receipt of the statement.
is the preferred doctor/clinic/hospital.
Date
Signature of parent/guardian
Relationship to child
Date
Signature of parent/guardian
Relationship to child
ADMINISTER PRESCRIPTION MEDICINE
I/we authorize
to administer prescribed medicine to my/our child as
specified in the prescription’s directions for administration.
Date
Signature of parent/guardian
Relationship to child
Date
Signature of parent/guardian
Relationship to child
ADMINISTER OVER-THE-COUNTER MEDICINE
(Administer only in accord with the appropriate standards for licensure)
I/we authorize
to administer over-the-counter medicine to my/our
child as specified in written instructions.
Date
Signature of parent/guardian
Relationship to child
Date
Signature of parent/guardian
Relationship to child
- over -
CHILD PICKUP
(Use additional sheet of paper if more than 3 people are authorized to pick up child)
I/we authorize
Name
Address
Phone
and/or
Name
Address
Phone
and/or
Name
Address
Phone
to pick up my/our child when I am/we are unavailable.
Date
Signature of parent/guardian
Relationship to child
Date
Signature of parent/guardian
Relationship to child
TRIPS, EXCURSIONS, AND PUBLIC PARK FACILITIES
I/we authorize
to take my/our child on walking trips, special
excursions, and to nearby public park facilities. I/we also authorize the child to ride as a passenger in the vehicle owned or leased by
the above-named person(s). I/we understand all such trips are under the supervision of the above-named person(s) and that health and
safety precautions are taken in compliance with DCFS standards for licensure.
Date
Signature of parent/guardian
Relationship to child
Date
Signature of parent/guardian
Relationship to child
SWIMMING
I/we consent to my/our child using the swimming pool of
Name of Provider
at
.
Address
Date
Signature of parent/guardian
Relationship to child
Date
Signature of parent/guardian
Relationship to child
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