Other than you, who else has permission to pick up you child?
In Case of an emergency, I give permission for any of the following individuals to be contacted any my child may be releaed any of them.
Who does not have permission to pick up your child? If applicable (A copy of supporting court document must be on file)
Child’s health information
Child’s medical insurance coverage
Consent to medical care and treatment of minor children
When I cannot be contacted. I authorize and consent to medical. surgical and hospital care. treatment and procedure to be performed for my child by licensed physician. health care provider, hospital or aid car attendant when deemed necessary or advisable by the physician or aid car attendant to safeguard my child’s health. I waive my right of informed consents to such treatment.
I also give my permission for my child to be transported by ambulance or aid car to an emergency center for treatment.
I certify under penalty of perjury under the laws of the state of Washington that this information is true and correct.
Our center offers several filed trips and special activities throughout the year. Transportation will be provided if necessary by Lil’ Red Barn Academy. You will be notified in advance of any scheduled field trip or event. Parents are responsible for any fess.
I release Lil’ Red Barn Academy to photograph and/or video my child while participating in daily activities and to use the photographs and/video in public display or other publication showing these daily activities.
I release Lil’ Red Barn Academy to photograph and/or video my child while participating in daily activities. These photographs will be used in house only. Example; field trips, special events, class picture etc.
Fill out the form below, and we’ll respond to you quickly!