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THER'S NAME: PHONIE: CELL PHONE WORK PHONE: EMAIL ADDRESS PHOI E FATHER'S NAME: CELL F'HONE: WORK PHONE: EMAIL ADDRESS: CONTACT IF PARENT CAN'T BE REACHED: CELL: TELEPHONE: In case of accident or serious injury, I hereby authorize the Atkinson Sun 'n Fun Stalif to make whatever arrangements are necessary for medical attention or care for my child. PARENT SIGNATURE. MEDICATIONS: LLERGIES / OTHER CONDITIONS: CHILD'S DOCTOR NAME: CHILD'S DOCTOR'S TELEPHONE NUMBER: TRIP RELEASE permission.

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