Additional adults (first and last name) who may pick up my child from Impression 5. (All adults listed above are included in pick-up list.)
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Child's Allergies *
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Please describe any support needs for your child.
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I understand that by sending my child to an Impression 5 Science Center L.A.B.S. camp, there is a risk of my child being exposed to COVID-19. *
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PHOTO RELEASE: Impression 5 will routinely publish in print, electronic, or video format the likeness or image of children enrolled in L.A.B.S. Programs in conjunction with Impression 5 programming and publicity. *
I give my permission for my child to participate in all the program-associated activities at the Science Center. I hereby authorize Impression 5 Science Center to seek emergency treatment for the child indicated above in the event that I cannot be reached.
Parent/Guardian Signature *
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Today's Date *
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