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University of Illinois Springfield

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Cox Children's Center University of Illinois Springfield

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Forms Overview

CHILD CARE INQUIRY:

Complete this form and bring it on to our center or email it to dbank1@uis.edu to be added to our waiting list.  We will call you if an opening is available.  Please note that priority is given to UIS students.

Family Intake Form:

This form should be completed to help us learn about your child and your family.

Permission to Give Medication:

This form should be taken with you to any doctor appointments your child has. In order to give any medication (prescription or over-the-counter) we will need to have this form completed by the ordering physician as well as yourself.

Permission for Over the Counter Creams Sunscreen Bug Repellants:

This form must be completed and signed in order for us to use any topical creams, ointments or sprays on your child.

Dietary Waiver:

This form must be completed by your child’s doctor for any foods that your child cannot have due to allergies.

Emergency Action Plan:

This form should be completed for any child that may have sever allergic reactions to food or insect bites. This must be completed by your child’s physician. Any child who requires and epi-pen must have this on file.

Request for One Week Vacation:

This form is to request a one week waiver of tuition. Your child must have been enrolled one full year and may only be requested once per year. Your child may not attend the week that vacation is requested. The form must be completed a minimum of two weeks in advance.

Request to Change or Withdraw Services:

This form is used if you need to change your child care services. We cannot guarantee that we will have the space to change days of care. This form is also use should you decide to withdraw your child from our center. This form must be turned in a minimum of two weeks in advance.

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University of Illinois Springfield
One University Plaza
Springfield, Illinois 62703-5407
217-206-6600

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