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Bilingual Nest

Bilingual Nest, 300 Manhattan Ave., New York, NY 10026


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Please Enter Child's Name Here
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Guardian 1

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Guardian 2

In case of Emergency name of relative or friend who can be called if we are unable to reach you:

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September - June

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Medical Statements and Consent

Bilingual Nest LLC is not permitted to administer any medication, if needed, please do so at home or after school.

I (we) authorize staff and Director of Bilingual Nest LLC 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 Bilingual Nest LLC 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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