Common use of PERMISSION FOR PHOTOGRAPHY Clause in Contracts

PERMISSION FOR PHOTOGRAPHY. Photographs will occasionally be taken of our children to display in the rooms, hallways, bulletin boards or to be used for publication in our local newspapers or the Coldwater Community School’s webpage. Please DO NOT photograph my child for any reason. I am aware that this permission slip will be valid for as long as my child is enrolled in this program or until I have submitted a written request to nullify all of the terms of this permission slip. Parent/Guardian Signature: Kids Club Childcare Center has my permission to take my child on short outings/walks to the park or surrounding area as part of our childcare program curriculum. Parent/Guardian Signature: Instructions: Unless otherwise indicated, all requested information must be provided. If the information is not known or does not apply, “unknown” or “none” is the required response. A blank field, a line through a field or “N/A” are not acceptable responses. For Date of Admission Provider Use Only: Date of Discharge Name of Child (Last, First, Middle Initial) Child’s Date of Birth / Address (Number and Street, Building/Apartment Number) City State Zip Code Parent/Legal Guardian’s Name Home Phone ( ) Parent/Legal Guardian’s Name (Optional) Home Phone ( ) Home Address (if not child’s address) Cell Phone ( ) Home Address (if not child’s address) Cell Phone ( ) City State Zip Code City State Zip Code Email Address (optional) Email Address Employer Name Work Phone ( ) Employer Name Work Phone ( ) Name of Child’s Physician or Health Clinic Physician’s or Health Clinic’s Phone Number ( ) Hospital Preferred for Emergency Treatment (optional) Allergies, Special Needs and Special Instructions (Attach additional sheets, if necessary.) BCAL-3731 (Rev. 6-17) Previous editions 4-16, 6-15 and 7-12 may be used until September 30, 2018. See Reverse Side

PERMISSION FOR PHOTOGRAPHY. Photographs will occasionally be taken of our children to display in the rooms, hallways, bulletin boards or to be used for publication in our local newspapers or the Coldwater Community School’s webpage. Please DO NOT photograph my child for any reason. I am aware that this permission slip will be valid for as long as my child is enrolled in this program or until I have submitted a written request to nullify all of the terms of this permission slip. Parent/Guardian Signature: Kids Club Childcare Center has my permission to take my child on short outings/walks to the park or surrounding area as part of our childcare program curriculum. Parent/Guardian Signature: Instructions: Unless otherwise indicated, all requested information must be provided. If the information is not known or does not apply, “unknown” or “none” is the required response. A blank field, a line through a field or “N/A” are not acceptable responses. For Date of Admission Provider Use Only: Date of Discharge Name of Child (Last, First, Middle Initial) Child’s Date of Birth / Address (Number and Street, Building/Apartment Number) City State Zip Code Parent/Legal Guardian’s Name Home Phone Phone( ) Parent/Legal Guardian’s Name (Optional) Home Phone Phone( ) Home Address (if not child’s address) Cell Phone Phone( ) Home Address (if not child’s address) Cell Phone Phone( ) City State Zip Code City State Zip Code Email Address (optional) Email Address Employer Name Work Phone Phone( ) Employer Name Work Phone Phone( ) Name of Child’s Physician or Health Clinic Physician’s or Health Clinic’s Phone Number ( ) Hospital Preferred for Emergency Treatment (optional) Allergies, Special Needs and Special Instructions (Attach additional sheets, if necessary.) BCAL-3731 (Rev. 6-17) Previous editions 4-16, 6-15 and 7-12 may be used until September 30, 2018. See Reverse Side