Student Forms

The Learning Center for Young Children (LCYC)

Student Forms

New Students
Please complete and turn in the following:

  • Bank Transfer Form (if desired)
  • Emergency Form (doctor signature not required)
  • LCYC Student Pick-up Authorization Form
  • Health Inventory Form
    • Part I (page 2) of Health Inventory Form-parent complete and sign
    • Part II (page 3) of Health Inventory Form-physician complete and sign
    • Immunizations (page 3) - attach a computer generated immunization record from your physician's office. Vaccination Requirements
    • Blood Lead Testing Certificate (page 4) - If your child's birthday falls after 1/1/15, have physician complete where indicated. If your child was born before 1/1/15, complete box A & B on the form to see if lead testing is required.
  • LCYC Student Allergy Form
  • If your child has allergies, Asthma (requiring medication at school), seizures, or will require medication (epipen, benadryl, etc.) to be given at school, please complete the appropriate form with your physician. Find the form under the heading "Medical Forms" below. Contact the LCYC office for more information.
  • Return forms to LCYC by July 27, 2018 via email to lcyc@warnermemorial.org, fax: (301) 933-7704, or mail to LCYC, 10123 Connecticut Ave., Kensington, MD 20895

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Student Forms
Miscellaneous Forms
Bank Transfer Form
Consumer Education Form; link to Consumer Education on Child Care brochure
Emergency Form (doctors signature not required)
Photo Release Form

Medical Forms
Allergy Action Plan (Must be accompanied by the Medication Admin. Auth. form)
Asthma Medication Admin. Auth. Form
Immunization Certificate
Lead Blood Testing Certificate
Health Inventory Form
Medication Administration Authorization
Seizure Medication Authorization
Vaccination Requirements


The Learning Center for Young Children

10123 Connecticut Ave., Kensington, MD 20895

301-949-2933
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