Emergency Information & Field Trip Permission

River of Life Christian School — Emergency Information & Field Trip Permission Form.

Family Last Name(Required)

Please list all last names.

List Student/Students Name and Grade(Required)

Address, City, & Zip(Required)

Home Phone #

Cell #(Required)

Parent(s)/Guardian(s) With Whom The Student Lives

Name(Required)

Phone #(Required)

Address, City, & Zip(Required)

Work #

Cell Phone #

Parent/Guardian Elsewhere

Please fill in this information only if we may contact this person in case of an emergency.

Name

Address, City, & Zip

Phone #

Home #

Work Phone #

Special custodial arrangements or unusual medical information

Please let us know of any special custodial arrangements (bring a copy of applicable court orders to your family interview) and any unusual medical information such as food or insect bite allergies, medication, seizures, etc.

Emergency Information

Person other than the primary parent to be contacted in an emergency when the parent is not available. Please provide a first contact and a secondary contact.

First Contact — Name & Relationship(Required)

First Contact — Phone #(Required)

Secondary Contact — Name & Relationship(Required)

Secondary Contact — Phone #(Required)

Additional Information or Comments

Health Care Facility Preferred

Insurance Company

Policy #

Medication Permission

Date of Last Tetanus Shot

List student(s) name followed by the date.

Known Allergies, Disabilities, or Illnesses to Note

List student(s) name followed by the details.

In order to assist parents/guardians in promoting and maintaining the health of students, River Of Life authorizes administration of prescribed and non-prescribed oral medication to students by the designated school employees, pursuant to a written request of the student’s parent/guardian.

Signature — Medical Treatment Authorization

In case of an emergency, I authorize River Of Life to obtain emergency medical treatment for my children. By inputting your name you are agreeing with all above and previously input information.

Field Trips & Liability

My child has permission to attend ALL field trips sponsored by River Of Life. I will not hold ROL liable in the case of an emergency while on school grounds or a school sponsored field trip. ROL will inform families of field trip information and details as they arise.

Signature — Field Trips & Liability

By inputting your name you are agreeing with all above and previously input information.

Internet/Picture Release

We desire to celebrate your child and his accomplishments and give glory to God. We also wish to share your child’s stories with others who wish to lift them up in prayer. We request your consent to post your child’s pictures and personally identifiable information (grade and first name only) on http://www.riveroflifeschool.org, http://www.facebook.com/riveroflifeschool, and other related websites, publications, newsletters, email lists, and other forms of reasonable media. We realize there are potential dangers associated with the posting of personally identifiable information on a web site since global access to the Internet does not allow us to control who may access such information. The law requires that we ask for your permission to use information about your child. We trust that God will protect our children. We also desire that your child is able to use the Internet for school activities. ROL has safeguards in place to protect our students from digital dangers, but despite the safeguards, we realize that the internet still poses a threat. We trust the Lord to protect our children. Please sign the following if you agree with these statements.

Name of Parent (Signature)

By inputting your name you are agreeing with/giving consent to all above and previously input information.

Date

Name of Child(ren)

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