University at Buffalo - The State University of New York
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Forms

Frequently used forms at your fingertips.

Extra Time Request

Extra days need prior approval & are granted as space allows.

Extra Time Request form (.pdf)

Schedule Change Request

Schedule changes can be requested by currently enrolled families at the end of each semester. They need approval and are granted as space allows.

To maintain consistency, we ask that requests for schedule changes not be made after the 3rd week of the semester.

Schedule Change Request form (.pdf)

Medical Statement of Child in Childcare (Annual)

This statement is required yearly for every child in our care. Families should take this statement to your child's yearly check-up to be filled out.

Also, families should request updated immunization reports and bring them in to the office after new immunizations are given. This will ensure that all medical files are current and up-to-date.

Annual Medical Statement form (.pdf)

Written Medication Consent (MED) Form

According to NYSOCFS regulations, children may not be given ANY medication without written instructions from the parent and the child’s physician stating that UBCCC Medication Trained Staff may administer it. A teacher in each room is trained to administer medications and they are certified by the NYSOCFS to do so.

All medication, including prescription medication and Over-the-Counter (OTC) medication, coming into UBCCC for administration to children must have written parental permission and must be in the original container, labeled with the child’s full name, medication name, recommended dosage, times and method of administration, and possible side effects.

When public health authorities recommend use of insect repellents due to a high risk of insect-borne disease, parents are asked to provide insect repellent containing DEET that staff will apply no more than once a day, with written instructions.

Medication Consent form (.pdf)

Parent Non-Medication Consent Form

Topical Ointments (non-medication) may be applied as needed with written parental consent. Sunscreen is applied to children before outside play. Parents are asked to provide sunscreen or sun block with UBF and UVA protection of SPF 15 or higher. Ointments to protect against diaper rash can also be used with written parental consent. 

This form allows the administration of (non-medication) topical ointments, sunscreen, lotion, etc.

Parent Non-Medication Consent form (.pdf)

Individual Health Care Plan for a Child With Special Health Care Needs

Working in collabortaion with the child's parent/guardian and child's health care provider, the following health care plan assists UBCCC in meeting your child's individual needs.

Individual Health Care Plan for a Child With Special Health Care Needs (.pdf)

Withdrawal Notice

Two weeks notice is required for any withdrawals from the center.  (Without two weeks notice, your initial tuition deposit will not be refunded.)

Withdrawal Notice form (.pdf)