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CHILD CARE WAIVER AND EMERGENCY CONTACT
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Parent annct be reached, Phone no.
Ue the urderigned a the parents) ofthe above named chidehiden arde agree, taking
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Twenty hrc of Ci: offers tees agents anclemployess fom any mn al dares demands,
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naliganceorirentonal mecondurt bythe ACU andi Uversty Cure, feof, agers ad
npleyes and further authenze bene ction unnersy to admins or ae be adn ere
‘St hvitur sole an and eperse medial wetmentancleredaten tothe sbeve named che
in he evr of ary emergen9
In she event the | cannct be reached o make arrangerentsforemergenry medial attention, lautrrize
the Abtane Chrstar Unversty child are cosrnatorcrpesonin charge taker cildta the Peete
Acer ond gh my ensant foray and al reste ny cd benthe nth
Lundertand that will be required toshow aval river’ ens eat tne that dep offand pickup
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"understand that Pesatc Ascats ml ete fast used in case of amedcal emergency
Signature of pam or guardian, ate
[NOTE To PaRenTs
‘Weredthe ntarmation the fist tine you bring your dikforcare. Each tine atarwarde plese wee the
signinsheet