Common Contracts
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SIERRA AT TAHOE CHID CARE CENTER REGISTRATION & LIABILITY RELEASE AGREEMENTNovember 18th, 2017
*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)
