Form Instructions:
Please print, complete and sign this form and mail it to NLF. Mail
completed forms to the following address:
Nihonmachi
Little Friends
Attn: Enrollment
2031 Bush Street
San Francisco, CA 94115
Or you may
request materials be sent to you
by mail.
| Name
of Child: |
|
| Today's
Date : |
|
In case of emergency, I give my consent for my child to
be taken for medical care and to receive the appropriate treatment:
|
| Name
of child's doctor: |
|
| Doctor's
Address : |
|
| Phone
Number : |
|
| Medical
Number : |
|
|
| I
grant permission for my child to be taken on field trips
during the Center's hours of operation; and consent for my child's
photographs, video, or any media coverage to be used to promote
Nihonmachi Little Friends. |
| Signature
of parent or guardian: |
|
| Relationship
to child: |
|
| Date: |
|
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