Childcare health history form for new enrollments
Collect a child's doctor, allergies, conditions, medicines and daily care needs on one form. Add your center details and download.
- Fill in your detailsYour center, room and dates.
- Make it yoursEdit, add or remove anything. Turn parts on or off.
- Check the previewIt updates as you type.
- Download PDFOr get a blank copy to fill in by hand.
Each section below shows what will print. Use the switch to keep or remove a section, edit the policy wording, and add your own questions at the bottom.
Your own questions
OptionalWhy a health history form matters
Teachers need to know about allergies, asthma, seizures and medicines before a child's first day, so they can act fast in an emergency. The form also helps you plan meals, naps and toileting the way the family does at home.
What to do with the form
- Read it with the family at enrollment and ask follow-up questions.
- Share allergies and conditions with every teacher who cares for the child.
- Make a care plan for allergies, asthma or seizures, signed by the doctor.
- Ask families to update it every year and when anything changes.
- Store it securely. Health information is private.
Related: allergy form, medication form, immunization record.
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Common questions
What should a childcare health history form include?
The child's doctor and insurance, allergies, medical conditions like asthma or seizures, regular medicines, eating, sleeping and toileting needs, any development concerns, and a parent signature.
How often should families update the health history?
At least once a year, and any time there is a new diagnosis, allergy or medicine.
Is this health history form free?
Yes. Add your details and download a printable form at no cost.