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Birch HillAmherst StBicentennialDr. CrispMain DunstableNew SearlesMt. Pleasant
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Lessons or performances might be photographed or videotaped with the intent to publish on our website, facebook page or utilize in grant applications.
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Permission to use child's name with photography.
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Allergies (Please list all allergies, select 'no' if student has no allergies)
I HEREBY AUTHORIZE ANY LICENSED PHYSICIAN, HOSPITAL, CLINIC OR OTHER MEDICAL FACILITY TO HOSPITALIZE AND SECURE PROPER TREATMENT FOR MY CHILD NAMED ABOVE
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