WP E-Signature by Approve Me - Sign Documents Using WordPress -

{{gravity-field-id-62}}-JAX Personal Rights

State of Florida Licensing Requirements:

a) The Department or licensing agency shall have the authority to interview children, or staff, and inspect and audit child or facility records without prior consent; and to observe the physical condition of the children, including conditions which could indicate abuse, neglect, or inappropriate placement, and have a licensed medical professional physically exam the children.
b) I understand I must provide current physical examination (Form 3040) and immunization record (form 680 or 681) within 30 days of enrollment, per section 65C-22.006(2), F.A.C.
c) I have received a copy of the Child Care facility Brochure, " Know Your Childcare Facility" (CP/PI 175/24, per section 402.3125(5), F.S.
d) I have been notified in writing of the guidance and disciplinary practices used by KidsPark (Parent Handbook), per section 65C.22.006(3)(c)2, F.A.C.

YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE RECEIVED THE ABOVE ITEMS AND THE INFORMATION ON THIS REGISTRATION FORM IS COMPLETE AND ACCURATE

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Signed by Chris Jackson
Signed On: September 5, 2023

Timestamp

Audit

September 3, 2023 3:03 am PST

{{gravity-field-id-62}}-JAX Personal Rights Uploaded by Chris Jackson - jaxfl@kidspark.com IP 95.90.241.244