Preschool Summer School Summer School Summer Registration Page 2
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Permission is hereby granted for my child________________________________________________
• To participate in all of the activities of the summer program and use all of the educational
and play equipment of the school and to leave the school premises on field trips in the
school buses.
• To be included in pictures connected with Summer Program for promotional and public
relations. No names will ever be used in conjunction with photos.
Permission is hereby granted for Summer Program staff members to take my child to an emergency
room or nearby physician for treatment in case of illness or injury. It is understood that the Summer
Program staff will make every effort to contact the parent(s)/guardian(s) of the child or their contact
person should they be unavailable. Summer Program staff will also attempt to contact the family
physician.
Permission is hereby granted for Summer Program staff members to administer the medications
checked off below without having to notify the parent(s)/guardian(s):
_____Acetaminophen
_____Ibuprofen
_____Benadryl
_____Cough suppressant
_____ Stomach medication
_____Other (specify) ___________________
Family Physician __________________________________Phone______________________
Dentist __________________________________________Phone______________________
Insurance Carrier __________________________________Policy #____________________
Hospital preference when available _______________________________
Please list and describe any allergies, conditions or behavioral needs your child may have and what, if
any, medications they will be taking while at Summer Program. All medications will be administered
by NGFS Summer Program staff. All medications must be in the original prescription bottle with
All medications must be in the original prescription bottle with
All medications must be in the original prescription bottle with
All medications must be in the original prescription bottle with
dosage labeled.
dosage labeled. _____________________________________________________________________
dosage labeled.
dosage labeled.
____________________________________________________________________________________
Please list any person that has permission to pick up your child from Summer Program other than a
parent/guardian already listed: _________________________________________________________
___________________________________________________________________________________
As a Quaker school, NGFS seeks to promote honesty, integrity and a sense of safety; therefore, if any
student enrolled in our Summer Program cannot adhere to these values, they will be removed from
the program without refund. Signing below verifies that you as parent(s)/guardian(s) understand this
policy of conduct and will comply with these provisions.
Parent/Guardian Signature ________________________________________Date_______________
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