Center Policies Signed Statement Parent / Guardian Name First Name Last Name Child's Name I hereby state that I have read and received a copy of this facility's following policies: Please check all that applies. Operational Policies Parent Involvement Policy Summary of the NC Child Care LAw I have read and received a copy of the facility's 100% Tobacco-Free Policy for the NC Child Care. I have read and received a copy of this facility's Shaken Baby Syndrome/ Abusive Head Trauma Policy (if applicable) Infant/Toddlers Safe Sleep Policy (SIDS Policy - if applicable) Date of Enrollment MM DD YYYY Type Parent Name to Sign & Date Childcare Provider Signature & Date Name of Chosen Care Representative & Date Thank you!
