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Saturday, 5:30 p.m. ____ Sunday, 8:30 a.m. ____ 11:00 a.m. ____ Varies ____ Emergency Contact Information (Please list individuals other than parents.) Contact #1 __________________________________ Home No. _____________________ Alt. No. _____________________ Emergency contact relationship to child?______________________________________________________________________ Contact #2 __________________________________ Home No. _____________________ Alt. No. _____________________ Emergency contact relationship to child?______________________________________________________________________ Medical Information Medical conditions impacting child s participation (food allergies, asthma, etc.) ________________________________________ Medication(s) child is currently taking ________________________________________________________________________ Medical Insurance Carrier________________________ Policy # ___________ Preferred Hospital/Clinic __________________ Pediatrician _________________________________________________ Office phone ________________________________ Pediatrician s address ___________________________________________________________________________________ PARENT RELEASES Medical Treatment: I hereby authorize the staff or volunteers of Sierra Vista United Methodist Church to obtain medical treatment for my child in the event of an emergency. I release Sierra Vista United Methodist Church, their employees, and volunteers from any claim of liability in connection therewith. _____ initial Events / Activities: I grant permission for my child to attend on-site and off-site events, activities, and programs of the Sierra Vista United Methodist Church in which he or she is enrolled. This permission includes bus rides to various activities. I will be notified in advance of all activities. _____ initial Publicity: I grant permission for my child to be included in Sierra Vista United Methodist Church directories and promotional materials which may include pictures and/or recordings on the SVUMC websites (http://www.sierravista.org and http://svumckids.blogspot.com) and/or in newspapers. _____initial Parent s Signature_____________________________________________________ Date ____________________ 2ЕHт1e &,    ┴   ╜   Й   Ж   N ─Hт1e(T`КЪ─┌BХ( "Ё$К■ИИИИИИИИ И И И И ИИИ И ИИ И И ИИ ИИ,И9"ЁDК "HК "0Ф& "рє $КИИИИИИИИИ И И И И ИИИ И ИИ И И ИИ ИИ,И9"рє DК " 0Ф& "m$КИИИИИИИИИ И И И И ИИИ И ИИ И И ИИ ИИ,И9"mDК " "и)0)Ц* "H╨т$КИИИИИИИИИ И И И И ИИИ И ИИ И И ИИ ИИ,И9"H╨DК " 0тФ& "И╢$КИИИИИИИИИ И И И И ИИИ И ИИ И И ИИ ИИ,И9"И╢DК "╚  Hт1e(8HXhxИШи╕    ~    ~    ~    ~    ~    ~    ~    ~    ~    ~ participation (food allergies, asthma, etc.) ________________________________________ Medication(s) child is currently taking ______2v┬─▓┤ЦШrtPR.0°·d f ` b · № ┌ ▄ ╛ └ Ь Ю АикавЖИtvPR,.02RT╘╓JL°°ЄюююЄюююЄююююююююююююююююююю°ююЄЄЄЄЄюфЄффффф┤иr`" X"6 "Г№  "°|" WК""" X"  X"0 "Г№  "°| WК""" X"   Lжикn╩─── 6 "Г№  "°|" WК""" X" ┬b Ь ° · АиPR,vLК$║$║$P$P$P$j " $КTИИИИИИИ,И7 >" j" $КTИИИИИИИ,И>" f" $КTИИИИИИИ,И>" v "┤!" $КTИИИИИИИ,И7 9"┤!>"  L─╥╓№:HL^ЦдnЪ0Ъ0Ъ0Ъ0Ъ0Ъj " $КTИИИИИИИ,И7 >" f" $КTИИИИИИИ,И>" ttLn$&Ln(*╚z+т1ХeHlАТд┤╞┌ъ■*<Tj|д╕Times New RomanSylfaenMangalVrinda Raavi Shruti Sendnya Latha GautamiTunga Angsana NewBatang MS MinchoPMingLiUSimSunEstrangelo EdessaMV BoliArial @w " "°|В"^"H"о"╚"Яo"`├E"рО"рО"рО "рО "ЇB  """ ""5%"К "№    "°|В"D7"Ь6"Ь9"\:"Яo"`├E"рО"рО"рО "рО "ЇB  """  ""5%"К "№   *""    " "    "    ВSVUMC websites (http://www.sie■      ┌Ў╚ЭЦ╤О└O╢■╬Quill96 Story Group Class    Ї9▓q