Emergency Medical Information
Full Name of Child ____________________________________ Nickname ____________________ Date of Birth_________ M / FParent(s)/guardian(s) _________________________________ Daytime Phone _________________ Cell Phone ________________Parent(s)/guardian(s) _________________________________ Daytime Phone_________________ Cell Phone ________________Street Address ______________________________________ City ______________ __________State_______ Zip __________ Person(s) to be notified in an emergency if neither parent can be reached:
Name __________________________________ Relationship ____________________ Daytime Phone ____________________
Name __________________________________ Relationship ____________________ Daytime Phone ____________________
If a current or recent medical problem is likely to make a first aid situation particularly stressful for your child,
please note the details here:

Child's Doctor _________________________________________ Phone _____________________Child's Dentist _________________________________________ Phone _____________________ MEDICAL INSURANCE INFORMATION
Family medical insurance company_____________________________________ Policy or Group # __________________________
Child's Medical Center # ________________________________________________
MEDICAL ALERTS/RESTRICTIONS: Please specify if your child has any of the following:
Dietary restriction________________________ ____________________________________________________________ Al ergies? _____________________________ ____________________________________________________________ Physical, emotional or learning needs?__________ ____________________________________________________________ Please list any medications that your child is currently taking:
Medication__________________________ Dose__________ Frequency__________ Name of licensed prescriber _______________
Medication__________________________ Dose__________ Frequency__________ Name of licensed prescriber _______________
NOTE: Please inform the camp if there are any changes in these listings during the summer.
IMMUNIZATION & PHYSICAL REPORT: Please include a copy of your child's immunizations and the most recent physical exam report by May 1st.
Attached: Yes No If NO, it wil be sent or faxed on (date) ______________________________
EMERGENCY MEDICAL RELEASE: In case of medical emergency at any time during my child's enrollment at Creative Arts at Park, I understand every
effort will be made to inform me (parent/guardian). In the event I cannot be reached, I hereby give permission to the physician selected by the Camp to hospi-
talize, secure proper treatment for, and order injection, anesthesia, or surgery for my child, as named on this medical form. I further agree to release and hold
harmless Creative Arts at Park and physician selected by the Camp from any liability arising out of such emergency treatment.
NON-PRESCRIPTION RELEASE: I give permission to the Camp nurse and/or other appropriate person to administer to my child the following non-
prescription medications (Tylenol, Motrin, Robitussin) in the event of headache, low-grade fever, complaints of minor aches, pains, or cold symptoms.
Parent/Guardian Signature _____________________________________________________ Date ___________________



[EB] APPENDIX J EXISTING BUILDINGS AND STRUCTURES SECTION AJ101 AJ102.4 Replacement windows. Regardless of the category PURPOSE AND INTENT of work, when an entire existing window, including frame,sash and glazed portion is replaced, the replacement window AJ101.1 General. The purpose of these provisions is to shall comply with the requirements of Section N1102.4. encourage the

Microsoft word - samba glycemic control consensus statement-summary-joshi.docx

Society for Ambulatory Anesthesia Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery Girish P. Joshi, MB BS, MD, FFARCSI Anesthesia & Analgesia 2010; 111: 1378-87 A systematic review of the literature was conducted according the protocol recommended by the Cochrane Collaboration. The consensus panel used the Grading

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