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DATE________
DEAR________
TODAY AT DAYCARE I HAD A SMALL ACCIDENT!
WHEN DID IT HAPPEN?
____________________________________________.WHAT HAPPENED?
_____________________________________________________________________.HOW DID IT HAPPEN?
_____________________________________________________________________.WHAT ACTION WAS TAKEN?
_____________________________________________________________________.WAS MEDICAL ATTENTION NECESSARY?
YES_____
NO _____IF SO, What action was taken
_____________________________________________________________________.SIGNATURE OF PARENT______________________________________
SIGNATURE OF PROVIDER____________________________________~form courtesy Debbie from Oklahoma, Little Ones Child Development Home