Text Box: Back Text Box: Permission Given for the Following: In an emergency, the child care home/facility has my permission to call an ambulance                       or take my child to any available physician or hospital at my expense. Y      N  In an emergency, the child care home/facility has my permission to obtain medical                treatment for my child, except for the restrictions listed. _______________________________________________________________ Y      N  My child may be given  prescribed medicine, when instructed by parent                                      (as (as prescribed by doctor) Y      N  My child may be given non-prescribed medicine, as instructed by parent. Y      N  My child may be taken on field trips or excursions by bus or private motor vehicle,                 under required supervision. Y      N  My child may participate in swimming or other water activities. Y      N  My child may be photographed for publicity or news purposes. Y      N  Please Indicate your Child’s Schedule: Summer: Days a week (2,3,5 option)                 Times                         Camps        Fall: Days a week (3,4,5 option)                 Times     Parent Signature______________________________________________   Back