ࡱ> GIFe bjbj "di\di\""4''''''''$5)+j,'U@,'WA':''J%h&ЂJք.%&W'0'%U,U, &U,&l,',''U,"> `: Just for Kids Permission Slip (5-12) Please bring with you to Check-In DATES OF THE PROGRAM: ______________________________ CHILDREN: _________________________________ AGE: ______ _________________________________ AGE: ______ _________________________________ AGE: ______ _________________________________ AGE: ______  PARENTS OR GUARDIANS NAME: ______________________________________________________________________ CELL PHONE #: ____________________________________________________________ ROOM#________________ CONFERENCE GROUP:______________________________________________________ WE MUST HAVE A WAY TO CONTACT YOU. PLEASE MAKE SURE TO INCLUDE THE COUNTRY CODE. May anyone else pick up your child? Yes / No If yes, please provide name, relationship to child, and contact phone number: _______________________________________________________________________________________________________ My child may participate in Just for Kids Field Trips Yes No Please list anything the staff may need to know regarding your child below: If your child has any potential life-threatening allergies or health conditions which could require immediate medical attention (such as peanut allergies, bee-sting allergies, asthma, or diabetes). If your child generally carries a medication auto-injector (i.e. Epipen or Twinject), an inhaler, or any other medication to treat emergency situations. Edelweiss Childrens Programs staff are trained to administer these medications, but are authorized to administer emergency medications only. ________________________________________________________________________________________________________________________________________________________________________________________________________________________ STATEMENT OF CONSENT: As legal guardian, I give my permission for the child named on this form to participate in all the activities associated with the Edelweiss Just for Kids Program (hereafter referred to as the program). I give my consent to the Edelweiss Staff to administer first aid and/or take my child to a medical facility to secure proper treatment, including anesthesia, hospitalization, or surgery. Treatment in an approved U.S. Army medical facility may be provided without consent under the provisions of AR 40-3. I also understand that a conscientious effort will be made to notify me prior to such actions. Expenses, if any, will be borne by me. I also understand the following aspects of the program in which my child is enrolled: (1) the program is NOT responsible for lost items; (2) activities are oriented towards GROUP rather than individual instruction; and (3) program staff CANNOT give constant individual attention and if the child named on this form cannot adjust or has a disciplinary problem which the staff cannot resolve, then he/she may be removed from this program. Due to this, ALL CHILDREN ARE ACCEPTED ON A TRIAL BASIS. I also understand that AV Staff are obligated to report any cases of suspected child abuse and/or neglect. Patrons whose children participate in any Edelweiss Childrens Program and/or Garmisch CYS programs are granted a temporary exception to the requirement of providing proof of immunization at the time of registration if the following conditions apply: Patrons are not permanently assigned to USAG Garmisch Patrons are in pre-deployment, R&R during deployment, or within 60 days of deployment status Patrons understand and have signed off on the registration form that, in the unforeseen event of a vaccine-preventable communicable disease outbreak, children without proof of immunization are no longer eligible for care PARENT/GUARDIAN SIGNATURE:_____________________________________ DATE:_______________ %&HIP  " J N Z \ ] e f g |  / 0 3 z ͽͽͽͽͽͽͽͽͽͦ}uŐuhxBCJaJhKQHCJaJh1hxBCJaJh1h_CJaJh1h'jCJaJhkOCJaJjhlThlTCJUaJha^CJaJhJoCJaJhlTCJaJhQeHCJ(aJ(h$|CJ(aJ(hOSCJ(aJ(h1h'jCJ(aJ(hJoCJ(aJ(*&HIJ& ] g 3 { L   R  ?$ & Fdha$gdJo$ & Fdha$gdX $dha$gdOS $da$gdX $da$gdOSdgdOSgdQeH$a$gdOSz { K L   Q R >?&/ñ֌vkv`vUvUvUvUvhF{hrCJaJhF{hJoCJaJhF{h CJaJhF{ho"CJaJhF{hF{CJaJhkOhJoCJaJhX6CJaJhJo6CJaJhJoCJaJ"jhJoCJUaJmHnHuh1hXCJaJh_CJaJhXCJaJh1h_CJaJh1h_5CJaJhkOhkOCJaJ?/'"Y $ & Fa$gdo"$a$gdr$a$gd'j $dha$gdJoh1hrCJaJhOSCJaJ hrhrhOShrhrCJaJ21h:p1/ =!"#$% K 01h:pa^/ =!"#$% P0 5 01h:plT/ =!"#$% \Dd N  C *Atop_logoR.E6/&QjnDoF.E6/&QjnJFIFddDuckyAdobed   #%'%#//33//@@@@@@@@@@@@@@@&&0##0+.'''.+550055@@?@@@@@@@@@@@@"!1AQ"aq2BRbr#3$CS4%6st!1AQaRq"2Br ?RJRR()JJRR()JJRR()JJRR()JJRR()JJRR()JJRR()JJP; 6.6f.L+;,Y2+)UU6m>iɓ2V1do0*7My8re8HauJ&0gad|k_J0&ުV??~g2:Mc3,1:fy_r2nAڴѧݗPǡAɝ߃8b8z:s%q-S7= l{1b]B=S <kx=QcYu,UǡdNs#NRO|c83aai꯹Fǐ{Le֒:y]nW(sqhqxBxWyu4.Ы]dLS>s^=+%n5pk]u5Ч;D̍en` `5[jj˻"Ƿdl%/! 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