Emergency Medical Information. We want your child to be safe, secure, and happy at our school as well as in After School Care. The information we request from you is extremely important in helping us to achieve the best care we can provide for your child. Please take the time to share all helpful information relating to your child. Should you fail to provide pertinent information regarding your child’s needs, Xxxx Help of Christians Catholic School and employees will not be held liable. We truly appreciate your support and disclosure of such information. Cell Phones: Cell phones must be always kept in the student’s backpack. If a student does not comply, the phone will be taken by the staff member and released to a parent at the time of pick-up. Students who need to contact their parent must ask permission from the aftercare staff member. Please complete, sign, and return the attached information sheet and agreement to the school office. XXXX HELP OF CHRISTIANS CATHOLIC SCHOOL AFTER SCHOOL CARE PROGRAM 2021-2022 INFORMATION SHEET Child’s Name Grade Child’s Name Grade Child’s Name Grade Parent’s Name(s) Phone # Phone # Primary Email Person allowed to pick up name Phone # Person allowed to pickup name Phone # Person allowed to pickup name Phone # Family Security Code Family Dismissal # Family Important Notes (ACKNOWLEDGEMENT OF TERMS AND AGREEMENT) IMPORTANT AFTER SCHOOL CARE PROGRAM INFORMATION NOTICE I HAVE READ AND HAVE A COPY OF THE AFTER SCHOOL CARE PROGRAM INFORMATION AND AGREE TO ADHERE TO THE TERMS.
Emergency Medical Information. Customer(s) have provided all emergency medical information relevant to the student as outlined on the Information & Registration Form.
Emergency Medical Information. Do you suffer from any of the following conditions? Allergies Diabetes Asthma
Emergency Medical Information. In the space below, please list any and all medical conditions and/or limitations that we should be aware of in order to accommodate the above participant's needs & ensure his/her safety. This includes, but is not limited to: allergies, behavioral issues, recent illnesses/hospitalizations, physical impairments & medications. It is best to include anything you would want an emergency medical worker to know if we have an emergency while your child(ren) are in our care. If there are none, please write "NONE" below. If more space is needed, please attach additional pages. Allergies/Limitations (Required): The Waterville Valley Recreation Department encourages everyone to participate in our programs. If your child has an individualized need due to a disability and may require a reasonable accommodation, in accordance with the Americans with Disabilities Act, to successfully participate, please contact the Waterville Valley Recreation Department to discuss your child's needs. Two weeks notice is needed to ensure appropriate accommodations can be provided.
Emergency Medical Information. Do you suffer from any of the following conditions? □ Allergies □ Asthma □ Convulsions □ Heart Trouble □ Diabetes □ Fainting Spells □ Bleeding Disorders □ Other (Specify) Do you wear □ Contact Lenses □ Dentures Are you currently taking any medications? (Please List) Emergency Contact Information STUDENT INFORMATION Address Home Phone Alternate Phone Email EMERGENCY CONTACT Name Relationship Address Home Phone Alternate Phone Email
Emergency Medical Information. Customer(s) have provided on exhibit a attached here to all emergency medical information relevant to the athlete.
Emergency Medical Information. (Please print legibly)
