I. Please help us better understand your child.
II. Care Needs
How does your child communicate with others?
III. Emergency Contacts (other than doctor)
IN CASE OF AN EMERGENCY, THE FOLLOWING PERSONS MAY BE CALLED AND ARE AUTHORIZED TO PICK UP MY CHILD: (At least one contact must be provided. Positive identification must be provided before your child will be released.)
IV. Permission/Authorization Agreement
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INITIAL IN THE DESIGNATED SPACE INDICATING THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO THE PROVISIONS.
I have read and initialed the above permission/authorization statements and agree to the terms designated in each: