Anthem Kids Check-in Form - Anthem Camarillo

Phone number *

Family Information

Please add all members of your household including additional parent/caregivers and children.

Household members

Diapering and Toilet Training Procedure

Anthem Kids staff may change diapers and/or provide toileting assistance under the following conditions:
- Parent has signed the consent
- There will be no application of ointments, creams, or powders
- Two staff are present for all toileting/diapering assistance

DIAPER CHANGING & TOILET TRAINING CONSENT *

By selecting an option below I give my permission for Anthem Kids Staff members to change my child's diaper and/or assist with toileting as necessary.