Phone (419) 784-5136 | Address: 1933 E 2nd Street Defiance, Ohio 43512


NOCAC staff will process child enrollment and health information in accordance with Ohio Department of Job and Family Services Day Care Licensing.


  1. NOCAC Staff will ensure a Child Enrollment and Health Information (EHI) is completed for every child during the enrollment process.
  2. All areas of the form need to be completed by the family. Staff will encourage families to write legibly and staff will ask questions if there is something on the form that is hard to read.
    1. Page 1
      1. “First Day at Program” or “First Home Visit” will be written in AFTER the child attends their first day, has his or her first home visit, or attends his or her first socialization.
      2. Only parents/legal guardians can be written in the “Parent/Guardian Name” section. Significant others may be listed as “Emergency Contacts”.
      3. Parent/Guardians need to complete all the areas.
      4. If an area does not apply to the family, NOCAC Staff will instruct the family to write “NA” in the box. (i.e. Parent/Guardian does not work or go to school)
      5. “Emergency Contact” section needs to have at least one person who can be contacted in the absence of the parent/legal guardian who is over 18 years of age and lives no more than one hour of the center.
    2. Page 2
      1. The family needs to answer all the questions.
      2. If the family marks “Yes” in any of the areas on page 2, NOCAC Staff will complete a Child-Medical-Care-Plan-ODJFS-2022 and/or Medication Administration JFS-01217 for each yes.
    1. Page 3
      1. Family needs to answer the first two questions.
      2. If the family indicates the child is not toilet trained, NOCAC Staff will complete a Potty Training Agreement with the family.
      3. “Emergency Transportation Authorization”
        1. The family completes only one section. NOCAC Staff will inform the family what happens if they do not give permission to transport.
      4. NOCAC Staff will ensure the parent checks yes for receiving a Family Handbook and Calendar.
      5. Parent and Administrator will sign and date.
      6. The bottom portion for Parent/Guardian Initials is only to be used when the form is updated by the parent.
  1. The teacher will give the completed EHI form to the Center Manager for review and signature.
    1. The Center Manager will ensure all areas of the form have been completed.
    2. The Center Manager will record the child’s “First Day at Program/Home” in the appropriate box.
    3. After reviewing and signing the EHI, the Center Manager will distribute the copies as follows:
      1. The white copy of the EHI form is kept in the bus book – Children may NOT be transported without a completed EHI on the bus.
      2. The yellow copy of the EHI form is kept in the child’s green file at the Center
      3. The pink copy of the EHI form is sent to the Administrative Assistant at the Central Office.
        1. NOCAC Staff will ensure the pink copy is legible before sending it in. If it is not, make a copy of the white and attach it to the pink copy.
  2. The EHI must be on file at the Center and in the bus book by the child’s first day of attendance.
  3. NOCAC Staff will instruct the family of the need to inform the classroom staff of any changes to the information listed on the EHI form.
    1. When changes are made to the form, the parent and administrator must initial and date at the bottom of page 3.
  4. The NOCAC Head Start/Early Head Start (HS/EHS) Center-Based Teacher will review the EHI form with the family during the first parent-teacher conference and second home visit.
  5. The NOCAC HS/EHS Home-Based Teacher will review the EHI form with the family in November and February.
  6. The bus driver is responsible for keeping the white copy of the EHI form updated.
  7. The teacher is responsible for keeping the yellow copy of the EHI form updated.
  8. The Administrative Assistant will use the pink copy of the form to update enrollment information as needed in ChildPlus.
    1. The Administrative Assistant will route the pink copy of the EHI to the Health and Safety Manager when there are health concerns noted by the parent.
  9. The EHI form will accompany a child when being transported for any reason such emergencies, dental days, medical appointments, field trip, routine walks, etc.

Forms and Additional Guidance:

This policy complies with the following

Head Start Program Performance Standard:    5101:2-12-15(A)
ODJFS Child Care Manual:    
CACFP Regulation:    
Caring for Our Children:    
Other Sources:    


Effective Date:   8/7/17 Reviewed Date:   6/11/21, 6/8/22
Approved By Policy Council:   8/7/17 Revision Approved By Policy Council: