Care Permissions Form Medication AuthorizationNo medication shall be given by a Trusting Connections employee without written permission of the parent or legal guardian. All prescription medication must be in the original container with the child’s name, name of the physician, medication name, and medication directions written on the label. Trusting Connections Employees may not administer personal medication; only medication provided by the family may be given to the children. Please select ONE of the following three options:OPTION 1: I permit Trusting Connections employees to administer any and all medications necessary, prescription or non-prescription, at the caregivers’ discretion. (Check all that apply.) I WOULD LIKE TO SELECT THIS OPTION. I would prefer that the nanny call a parent or guardian before administering medication, if possible. OPTION 2: I permit Trusting Connections employees to ONLY administer the following medications for the reasons specified below. I WOULD LIKE TO SELECT THIS OPTION. Please list any and all medications you would like to authorize AND note under what circumstances the listed medications my may administered. (For example, ".25 ml of Tylenol for pain associated with teething." Please be specific.OPTION 3: I DO NOT permit Trusting Connections employees to administer medication of any kind unless written permission is given to administer medication on the Temporary Authorization form for the day(s) specified. I WOULD LIKE TO SELECT THIS OPTION. Driving AuthorizationWritten permission must be given for a Trusting Connections employee to transport children. The employee is required to observe all safety regulations including seat belt and proper car seat use. If the employee uses her own vehicle for on-the-job driving, she will be reimbursed at the national standard rate. Any mileage charges accrued will be noted on the client’s receipt. Employees are not permitted to install car seats into any vehicle other than their own. If a family vehicle is provided, all car seats must be installed by the client. Verbal consent will not be accepted. Please select ONE of the following three options:OPTION 1: I permit Trusting Connections employees to drive my child(ren) for any childcare-related reason. (Check all that apply.) I WOULD LIKE TO SELECT THIS OPTION. I would prefer that the nanny call a parent/guardian before transporting the child(ren), if possible. I would like the nanny to use her own vehicle. I would like the nanny to use the vehicle provided by our family. OPTION 2: I permit Trusting Connections nannies to drive my child(ren) under select circumstances. (You will have the opportunity to specify below.) I WOULD LIKE TO SELECT THIS OPTION. I would like the nanny to use her own vehicle. I would like the nanny to use the vehicle provided by our family. Please explain. List locations the nanny is permitted to transport the children to and from and for what purposes this permission is granted.OPTION 3: I do not permit Trusting Connections nannies to drive my child(ren) for any reason, other than a legitimate emergency, unless written permission is given on the Temporary Authorization form for the day(s) specified. I WOULD LIKE TO SELECT THIS OPTION. Photo Release AuthorizationOur nannies have many special moments with children throughout their careers with our agency and we would love to use/share images captured by our nannies with your permission. Please indicate below if we have permission to use your child’s photograph publicly to promote our agency. The images may be used in print publications, online publications, presentations, websites, and social media. No royalty, fee or other compensation shall become payable to the client by reason of such use. Please know that TC employees are STRICTLY prohibited from taking photos of clients' children without permission. Please indicate your preference below. Please select ONE of the following two options:OPTION 1: I permit Trusting Connections employees to occasionally take photos of my child(ren) for the uses listed above. (Check all that apply.) I WOULD LIKE TO SELECT THIS OPTION. I consent as long as the nanny shares the photo with a parent/guardian and seeks approval prior to giving the photo to the agency. I consent as long as my child's face is not directly visible. OPTION 2: I do not permit Trusting Connections employees to take photos of my child(ren) for any reason. I WOULD LIKE TO SELECT THIS OPTION. Release to a Minor AuthorizationSome of our families prefer that our caregivers release the children to an older sibling or younger babysitter at the end of the shift. In order to do this, we need written permission. Please choose one of the following options. Are our caregivers permitted to release the children in their care to another minor, (12 years or older) upon request?* YES, I permit Trusting Connections' caregivers to release my children to a minor if they are instructed to do so. NO, my children may only be released to myself or another authorized adult Email Please enter your email address to receive a copy of your submission. Name* First Last Signature*Date* MM slash DD slash YYYY CAPTCHA