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** PLEASE BE AWARE WE DO NOT ADMINISTER MEDICATION **
Inhalers and Epi-pens should be given to the Director in case they are needed.
Please fill out the safety precautionary form below and return it by the first day of the program. A physical examination is not required. Please fill in any information that we may need in case of an emergency.
By checking the "I agree" box below, you agree and acknowledge that in the event I cannot be reached in an emergency, I hereby give permission to the physician, selected by the adult leader in charge, to hospitalize, administer proper anesthesia, or to order injection or surgery for my child, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
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