Two girls sitting in a plastic tub



In accordance with Minnesota State Licensing requirements, parents must submit a statement certifying the date of the child’s last physical examination, the child’s immunization records, a list of specific health needs, and the name, address and telephone number of the child’s physician.  At the discretion of the director, documentation of a negative screening test for certain infectious diseases may be required prior to enrollment.
The following forms are required:

  • Medical Record and Health Care Summary
  • Child Care Immunization Record
  • Administration of Diaper Rash Ointments, Pre-moistened Commercial Wipes, and Sunscreen


  • Allinformation obtained regarding any center family/child(ren) is considered confidential.
  • Information obtained and collected by our program will be shared with other staff on a "need to know" basis.  The lead teachers may use the information during in-service trainings to identify children’s interests and needs.
  • Practicum students and volunteers are not to be included in discussions of children and families, except for information which is relevant in order for them to complete their objectives. 
  • All confidential materials will remain in a lockable filing cabinet in the office.
  • All parents/guardians may gain access to their child’s information by either asking the lead teacher, associate director, or director.
  • No information can be shared with an outside agency without written consent from the legal guardian.  The decision to share information will be made by administrative staff (lead teachers, director).
  • On request, the Regulatory authorities (Minnesota Department of Human Services) of the Lindgren Child Care Center will have access to our confidential materials.
  • Medical Record and Health Care Summary Appendix IV-D
  • Child Care Immunization Record, Appendix IV-E
  • Administration of Diaper Rash Ointments, etc., Appendix IV-F


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