Common Contracts
2 similar null contracts
SIERRA AT TAHOE CHID CARE CENTER REGISTRATION & LIABILITY RELEASE AGREEMENTOctober 1st, 2021
CHILD’S LAST NAME CHILD’S FIRST NAME AGE DATE OF BIRTH MALE/FEMALE PARTICIPANT IS IN GOOD HEALTH & HAS HAD ALL NECESSARY IMMUNIZATIONS. X (Signature) ALLERGIES, MEDICATIONS, AND MEDICAL & OTHER CONDITIONS THAT MAY AFFECT THE PARTICIPANT PARENT/GUARDIAN NAME (PLEASE PRINT) ( ) CELL PHONE NUMBER MAILING ADDRESS CITY STATE ZIP ADDITIONAL PERSON(S) AUTHORIZED TO PICK UP MY CHILD e-mail DRIVER’S LICENSE (STATE AND NUMBER)
SIERRA AT TAHOE CHID CARE CENTER REGISTRATION & LIABILITY RELEASE AGREEMENTJanuary 3rd, 2018
CHILD’S LAST NAME CHILD’S FIRST NAME AGE DATE OF BIRTH MALE/FEMALE PARTICIPANT IS IN GOOD HEALTH & HAS HAD ALL NECESSARY IMMUNIZATIONS. X (Signature) ALLERGIES, MEDICATIONS, AND MEDICAL & OTHER CONDITIONS THAT MAY AFFECT THE PARTICIPANT PARENT/GUARDIAN NAME (PLEASE PRINT) ( ) CELL PHONE NUMBER MAILING ADDRESS CITY STATE ZIP ADDITIONAL PERSON(S) AUTHORIZED TO PICK UP MY CHILD e-mail DRIVER’S LICENSE (STATE AND NUMBER)
