Registration Packet

Gio’s Garden has created a few forms to help us better understand your child’s special needs so that we can provide him or her with high quality, personalized care. Please fill out all of the forms to the best of your ability and email/mail to Gio’s Garden.

Gio’s Garden Forms Needed:

Respite Care Application
Provider Referral
Media Release
Permission Slip
Field Trip Form
Sick Child Policy
Seizure Action Plan (if applicable)
Feeding Tube Administration (if applicable)

State Forms Needed:

Child Care Enrollment
Health History and Emergency Care Plan
Child Health Report (signed by MD, PA)
Copy of Immunization Records (provided by medical provider, can also be from MyChart)
Intake for Child Under 2 years (if child is under 2 years old)

Formularios Necesarios Para El Jardín de Gio:

Aplicación de Gio’s Garden
Referencia de Prove edor
Comunicado de Prensa
For mulario de Permiso
F o rmulario de Permiso par a Excursión y Natación
Política de Niños Enfermo s
Plan de Acción pa ra Crisis Epilépticas Gio's Gar den (si corresponde)
Administración d e sonda de alimentación (si corresponde)

Formularios Estatales Necesario s :

Inscripción en Programas de Cuidado Infanti l
Historial De Salud y Pl an De Atención De Emergenci a
Informe de Salud Inf antil(firmado por MD, PA)
Registro de Inmunizacion es(proporcionado por el proveedor médico, también puede ser de MyChart)
Admisión Para Niños Menores Que 2 Años(si el niño tiene menos de 2 años)

Please fill out all forms and mail to:

Gio’s Garden, 2028 Parmenter St, Middleton, WI 53562

Or scan and email to Middleton@GiosGarden.org

If you have any questions, please contact us at 608-833-4467, ext 4 or Middleton@GiosGarden.org