Untitled Document

Child's Name:

Age:

Grade (entering):

Birthdate:

Parent or Guardian's Name:

Street Address:

City:

State:

Zip:

Home Telephone:

Cell or Work Telephone:

Email Address:

Emergency Contact:

Phone:

Medical Information / Allergies / Adaptations:

Family Doctor:

Phone:

Preferred Hospital:

Curator Club Fall 2008 Schedule - Please check the activities your child will be attending:

	February 7th Celebrate Groundhog Day!		March 21st Forces of Nature
	February 21st Abracadabra!		April 4th Rockin’ Robin
	March 7th Danger! Plants!		April 18th Gross Me Out!

Photo Permission

I give permission for my child's photograph to be taken during Curator Club activities. I understand the photographs may be used in the Oakes Museum newsletter or promotional material (which may include our web site) or for staff professional portfolios.

Parent Signature:

Date:

Permission to Pick Up Your Child

At the end of Curato's Club we will only release your child to those who may pick up your child. I authorize the following individuals to pick up my child from the Oakes Museum Curator's Club.

Name:

Phone:

Parent Signature:

Date:

If you need to make arrangements for another person to pick up your child during Curator Club sessions, please provide us with a written and signed note of permission.