VIP & Sibling Forms
Select the form that you want to open. From there you can print the form and fill it out. All of these forms are provided in a PDF format and may take a couple moments to open.
If you are ready to attend orientation and want to fill out the forms before you go, please complete each of the forms #1-4.
If you simply want to give us new or updated information, please scroll down to find #5 the VIP Information Update Form.
1. VIP Family Information Form : This is the main form that you need to fill out and it includes contact and medical information as well as behavioral, communication, dietary, and hygiene skills so that we can provide the best care possible for your child.
2. Sibling Info Form: Buddy Break is open to siblings of VIPs and we’d love to have them come play with us! This form gives us information that is pertinent to the care of the sibling.
3. Authorization & Release Form: This form gives the Buddy Break location ability to arrange for emergency medical attention if that becomes necessary for your child. You may complete one form to cover VIPs and siblings or separate forms for each child. This form must be notarized. We provide a notary at the orientation so bring the form filled out except for your signature.
4. Declaration of Consent Form: This form includes sections on liability and image release, which allows us to use your child’s picture in marketing or promotional pieces. You can choose to not sign particular sections of this form. You may complete one form to cover VIPs and siblings or separate forms for each child. It also needs to be notarized.
5. VIP Information Update Form: If any of your information changes, please let us know by filling out the updated information on this form. You can bring it to any of the Buddy Break locations or scan and email it to Stephanie directly. We will also have this form available at all Buddy Breaks.
The following forms must be notarized. You may take them to a bank, credit union, or bring it to the next Buddy Break and we will have our notary available.
*Please let us know ahead of time if you need our notary so we can contact him to have him at the facility.
If you have any questions, please contact us at [email protected] or 513.531.3626.
Select the form that you want to open. From there you can print the form and fill it out. All of these forms are provided in a PDF format and may take a couple moments to open.
If you are ready to attend orientation and want to fill out the forms before you go, please complete each of the forms #1-4.
If you simply want to give us new or updated information, please scroll down to find #5 the VIP Information Update Form.
1. VIP Family Information Form : This is the main form that you need to fill out and it includes contact and medical information as well as behavioral, communication, dietary, and hygiene skills so that we can provide the best care possible for your child.
2. Sibling Info Form: Buddy Break is open to siblings of VIPs and we’d love to have them come play with us! This form gives us information that is pertinent to the care of the sibling.
3. Authorization & Release Form: This form gives the Buddy Break location ability to arrange for emergency medical attention if that becomes necessary for your child. You may complete one form to cover VIPs and siblings or separate forms for each child. This form must be notarized. We provide a notary at the orientation so bring the form filled out except for your signature.
4. Declaration of Consent Form: This form includes sections on liability and image release, which allows us to use your child’s picture in marketing or promotional pieces. You can choose to not sign particular sections of this form. You may complete one form to cover VIPs and siblings or separate forms for each child. It also needs to be notarized.
5. VIP Information Update Form: If any of your information changes, please let us know by filling out the updated information on this form. You can bring it to any of the Buddy Break locations or scan and email it to Stephanie directly. We will also have this form available at all Buddy Breaks.
The following forms must be notarized. You may take them to a bank, credit union, or bring it to the next Buddy Break and we will have our notary available.
*Please let us know ahead of time if you need our notary so we can contact him to have him at the facility.
If you have any questions, please contact us at [email protected] or 513.531.3626.