Drop Off Program Sign In

Please refer to the Exclusion Summary from the Oregon Early Learning Division if you need any clarification about attending our program.

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Parent First Name

Parent Last Name

Phone

Child First Name

Child Last Name

+ Add additional child

I affirm that neither my child nor I, nor any other immediate family member, has experienced fever (temperature above 100.4 F) in the last 24 hours.

I affirm that neither my child nor I, nor any other immediate family member, has experienced any signs of illness, including runny nose, cough, new loss of taste or smell, or shortness of breath in the last 24 hours.

Today's Date

For today, the person picking up my child from class will be (if applicable):

Chaperone Name

Chaperone Phone