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2. BRISTOL DAY CARE REGISTRATION FORM FOR EMERGENCY NOTIFICATION BY POLICE
   Effective October 1, 2015, under CT Public Act 15-161, day care centers are required to register certain information with their local law enforcement agency. By registering, law enforcement can notify day care centers of certain emergencies that include fire, a criminal act, an emergency or act of nature such as an earthquake, tornado, hurricane or storm, in the vicinity of such day care center that may endanger the safety or welfare of the children at such day care center.
4. IMPORTANT:
   If your day care receives an automated message from law enforcement, listen to the entire message, determine if it applies to your facility, and take the appropriate action.
6. CHANGES TO CONTACT INFORMATION:
   If any of your contact information changes, promptly notify Bristol PD: (860) 584-3011
8. NAME OF DAY CARE FACILITY:*
10. DAY CARE ADDRESS:*
    Bristol CT 06010
12. NAME OF LICENSEE:*
14. CONNECTICUT LICENSE NUMBER:*
16. PRIMARY PHONE FOR NOTIFICATIONS:*
17. TYPE:*

    1. Land
    2. Cell
19. SECONDARY PHONE (OPTIONAL):
20. TYPE:

    1. Land
    2. Cell
22. COMMENTS:
24. REGISTRATION DATE:*
    REGISTRATION DATE:
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

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