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  • List telephone numbers below where parents/guardian may be reached while child will be in care:
  • Give the name, address and phone number of person to call in case of an emergency if parents / guardian cannot be reached:
  • I hereby authorize the childcare operation to allow my child to leave the childcare operation ONLY with the following persons. Please list name & telephone number for each. Children will only be released to a parent or a person designated by the parent/guardian after verification of ID.
  • CHECK ALL THAT APPLY

  • Transformation:

  • Fields Trip

    my consent for my child to participate in Field Trips
  • Water Activities

  • RECEIPT OF WRITTEN OPERATIONAL POLICIES:

    I acknowledge receipt of the facility’s operational policies including those for discipline and guidance.
  • AUTHORIZATION FOR EMERGENCY MEDICAL ATTENTION:

    In the event I cannot be reached to make arrangements for emergency medical care, I authorize the person in charge to take my child to:
  • I give consent for the facility to secure any and all necessary emergency medical care for my child.