Summer Conditioning Program

Parent Information
Parent's Name

First NameLast Name
Parent's Email
example@example.com
Parent's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Who has permission to pick up your child other than parent/guardian?
Who may we contact, other than parents, in the event of an emergency

First NameLast Name
Emergency contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
In the event of an extreme emergency and you can not be reached, may we contact the medical emergency personnel?

Emergency Medical Authorization
Should student listed above suffer and injury or illness while at Byne Christian School or in a school vehicle and the school personnel is unable to conatact me immediately, the school shall be authorized to secure such medical attention and care for my child as may be necessary. i agree to keep the school informed of changed in telephone numbers where I can be reached.
My child's primary source of health care is? Physician or Clinic Name
Physician or Clinic Telephone #
Please enter a valid phone number.Format: (000) 000-0000.
Medication Release
For your child's well-being, parents will be contacted before administering any of the following medications. All medications will be administered through the school office. Please indicate yes or no. (If yes indicate dosage)
Ibuprofen*
Tylenol*
Antacid (Chewable Only)
Cough Drops (Only one administered per day)
* A chewable form and liquid form of the medications are available for the lower elementary only.
Known medical conditions (i.e) diabetes, asthma, drug or food allergies:
Parent Signature
Date

MonthDayYear
Date

Rules & Regulations