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Student Record & Release Form

Student Record & Release Form

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  • CHILD INFORMATION

  • PARENT INFORMATION

  • SIBLING INFORMATION

  • GRANDPARENT INFORMATION

  • MEDICAL INFORMATION

  • EMERGENCY CONTACT INFORMATION

  • Dismissal Procedures 

    1. In order to take every possible safety measure at dismissal, we require that each person, othan than a parent, authorized to pick up your child be known to your child's teacher and to the director.  In the event that someone not listed below will be picking up your child, please call the school with the individual's name and physical description. 

  • 2. In the event that your child is not picked up from school and we are unable to notify you or any of the contacts, we will call another parent from the school to take your child to their home until you are contacted.  Please indicate two other parents (preferably parents of your child's friends) with whom we may leave your child.

  •  Releases

    TRIPS
    For the school year September 2017 - June 2018: I hereby give my child permission to go on walking trips in the neighborhood and on the trips via school bus or public transportation.  I understand that I will receive notification of upcoming trips through the school calendar or email.  I further understand that the children may go on walking trips in the neighborhood without prior notification.

  • EMERGENCY POLICY
    In case of a medical emergency, G-d Forbid, the school will call Hatzalah.  If the Emergency Responders decide that the situation warrants swift medical attention, your child will be taken to the nearest hospital together with his/her medical file.  Parents will be immediately notified.  Until a parent is reached, the director or teacher will be in charge and make all decisions about the care of your child.  In all non-emergency situations, the parents will be contacted.  If parents cannot be reached, we will contact your pediatrition and follow instructions.  In situations where your child must be taken home and you cannot be reached, we will contact the people indicated above.  By signing this form, you also consent to assume any and all fiscal responsibilities incurred by the school in the course of your child's medical emergency.  
    I hereby authorize the Osher Early Learning Center to obtain necessary medical treatment for my child in accordance with the above mentioned Emergency Policy.

  • SUNSCREEN, ANTISEPTIC & DIAPER CREAM
    For the school year September 2017 - June 2018, I hereby give permission to the staff of the Osher Early Learning Center to apply topical over-the-counter creams to my child according to label instructions.

  • MEDIA RELEASE
    For the school year September 2017 - June 2018, I hereby give the Osher Early Learning Center permission to use my child's likeness for publicity purposes to help promote their program.

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