{"id":30,"date":"2018-10-25T11:15:07","date_gmt":"2018-10-25T15:15:07","guid":{"rendered":"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/?page_id=30"},"modified":"2025-10-14T09:39:27","modified_gmt":"2025-10-14T13:39:27","slug":"forms","status":"publish","type":"page","link":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"<span class=\"prpl-button\"><a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2024\/08\/Wait-List-Enrollment-Form.docx\">Wait List Enrollment Form<\/a><\/span>\n<p><strong>Calendar<\/strong><br \/>\n<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2025\/10\/BSCC-2025-26-Calendar.pdf\">Calendar 2025-26<\/a><\/p>\n<p><strong>Medical Forms<\/strong><\/p>\n<ul>\n<li>Health Certificate for Infants\/Toddlers (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/HealthCertInfantToddler.pdf\">PDF<\/a> \/ <a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/HealthCertInfantToddler.doc\">Word<\/a>)<\/li>\n<li>Universal Health Record (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/UniversalChildHealth.pdf\">PDF<\/a> \/ <a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/UniversalChildHealth.doc\">Word<\/a>)<\/li>\n<li>Non-Prescription Medication Form (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2022\/02\/Non-Prescription-Med-form-2-17-22.pdf\">PDF<\/a>)<\/li>\n<li>Medical Consent Form (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/MedicalNotarizedConsentForm.pdf\">PDF<\/a> \/ <a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/MedicalNotarizedConsentForm.doc\">Word<\/a>)<\/li>\n<\/ul>\n<p><strong>Allergy Requiring Epinephrine<\/strong><\/p>\n<ul>\n<li>Parent Allergy Information Letter (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Food-Allergy-Epinephrine-Parent-Letter-5-2021.pdf\">PDF<\/a> \/ <a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Food-Allergy-Epinephrine-Parent-Letter-5-2021.doc\">Word<\/a>)<\/li>\n<li>Allergy Alert Form (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Allergy-Asthma-RAD-Alert-form-2021.pdf\">PDF<\/a>)<\/li>\n<li>Food Allergy Action Plan (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Action-Plan-Food-Allergy-emergency-care-plan.pdf\">PDF<\/a>)<\/li>\n<li>Permission to Administer Epinephrine (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/08\/EpiConsent-8-30-21.pdf\">PDF<\/a> \/ <a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/08\/EpiConsent-8-30-21.doc\">Word<\/a>)<\/li>\n<li>Individual Permission for Medication\/Health Care Procedure (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Individual-Permission-for-Medication-Healthcare-Procedure.pdf\">PDF<\/a>)<\/li>\n<\/ul>\n<p><strong>Asthma<\/strong><\/p>\n<ul>\n<li>Parent Asthma Information Letter (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Asthma-RAD-Respiratory-Parent-Info-letter-5-21-1.pdf\">PDF<\/a>)<\/li>\n<li>Allergy\/Asthma\/RAD Alert Form (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Allergy-Asthma-RAD-Alert-form-2021.pdf\">PDF<\/a>)<\/li>\n<li>Asthma Action Plan (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Asthma-Action-Plan.pdf\">PDF<\/a>)<\/li>\n<li>Individual Permission for Medication\/Health Care Procedure (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Individual-Permission-for-Medication-Healthcare-Procedure.pdf\">PDF<\/a>)<\/li>\n<\/ul>\n<p><strong>All Other Allergies<\/strong><\/p>\n<ul>\n<li>Allergy Alert (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Allergy-Asthma-RAD-Alert-form-2021.pdf\">PDF<\/a>)<\/li>\n<li>Individual Permission for Medication\/Health Care Procedure (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Individual-Permission-for-Medication-Healthcare-Procedure.pdf\">PDF<\/a>)<\/li>\n<\/ul>\n<p><strong>Other Forms<\/strong><\/p>\n<ul>\n<li>Emergency Information Form (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Emergency-Info-Form.pdf\">PDF<\/a> \/ <a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Emergency-Info-Form.doc\">Word<\/a>)<\/li>\n<li>Individual Permission for Medication\/Health Care Procedure (<a href=\"http:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-content\/uploads\/sites\/175\/2021\/05\/Individual-Permission-for-Medication-Healthcare-Procedure.pdf\">PDF<\/a>)<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Calendar Calendar 2025-26 Medical Forms Health Certificate for Infants\/Toddlers (PDF \/ Word) Universal Health Record (PDF \/ Word) Non-Prescription Medication Form (PDF) Medical Consent Form (PDF \/ Word) Allergy Requiring Epinephrine Parent Allergy Information Letter (PDF \/ Word) Allergy Alert Form (PDF) Food Allergy Action Plan (PDF) Permission to Administer Epinephrine (PDF \/ Word) Individual [&hellip;]<\/p>\n","protected":false},"author":37,"featured_media":196,"parent":0,"menu_order":5,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-30","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-json\/wp\/v2\/pages\/30","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-json\/wp\/v2\/users\/37"}],"replies":[{"embeddable":true,"href":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-json\/wp\/v2\/comments?post=30"}],"version-history":[{"count":19,"href":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-json\/wp\/v2\/pages\/30\/revisions"}],"predecessor-version":[{"id":381,"href":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-json\/wp\/v2\/pages\/30\/revisions\/381"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-json\/wp\/v2\/media\/196"}],"wp:attachment":[{"href":"https:\/\/www.montclair.edu\/ben-samuels-childrens-center\/wp-json\/wp\/v2\/media?parent=30"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}