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Get Oh Rocky River High School Authorization Waiver Form 2014-2024

ROCKY RIVER HIGH SCHOOL PLAY-SCHOOL REGISTRATION AND EMERGENCY MEDICAL AUTHORIZATION WAIVER FORM Child s Name Age Birth Date Parent s/Parent Name Home Address E-mail address Phone number where you can be reached during play school hours Allergies Medications your child is currently taking Foods to be avoided Child s Interests ANY OTHER INFORMATION ABOUT CHILD THAT WE SHOULD BE AWARE OF In case of an emergency and you can not be reached please provide the name and number of your closest relative or friend Name Phone Number EMERGENCY TREATMENT In the event of illness or accident which requires immediate medical treatment at a time when a parent cannot be located I giver permission for the R.R.H. S* to provide emergency treated to the best of their knowledge and ability. I will not hold the school or medical personnel responsible. This is done with the understanding that every attempt will be made to contact a parent the child s physician and other persons listed for emergency contact. SIGNED DATE RRHS Play School Photo Video and Audio Permission I authorize the Rocky River City School District to publish in print or post on the web any photos video or audio of my child or my child s work as during the year the district often uses photography video or audio to illustrate student projects events accomplishments and activities. S* to provide emergency treated to the best of their knowledge and ability. I will not hold the school or medical personnel responsible. This is done with the understanding that every attempt will be made to contact a parent the child s physician and other persons listed for emergency contact. This is done with the understanding that every attempt will be made to contact a parent the child s physician and other persons listed for emergency contact. SIGNED DATE RRHS Play School Photo Video and Audio Permission I authorize the Rocky River City School District to publish in print or post on the web any photos video or audio of my child or my child s work as during the year the district often uses photography video or audio to illustrate student projects events accomplishments and activities. S* to provide emergency treated to the best of their knowledge and ability. I will not hold the school or medical personnel responsible. This is done with the understanding that every attempt will be made to contact a parent the child s physician and other persons listed for emergency contact. SIGNED DATE RRHS Play School Photo Video and Audio Permission I authorize the Rocky River City School District to publish in print or post on the web any photos video or audio of my child or my child s work as during the year the district often uses photography video or audio to illustrate student projects events accomplishments and activities.

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