COPY AND PASTE - NO TIME TO WASTE!
We have several forms on our site that you may want to copy and paste to save in your personal documents. You can print forms such as the Field Trip Permission Form, Medication Administration Form, and Evergreen Media Form. Having access to these documents should make things easier for everyone!
In case of an emergency, please contact:
Evergreen Touchstones
Request for Medication Administration
please check ALL that apply
___prescription medication ____refrigeration required___food supplement
___nonprescription medication ___topical product ____modified diet
Name of child:________________________________
Date of birth:_________________________________
Name of Medication:____________________________
Exact Dosage:_________________________________
How many days will this be administered:_____________
Parent/Guardian Signature:_______________________Date:__________
*Time of last dose:________
A licensed physician must complete this form if: The medication requested is not age or weight appropriate, the medication is a sample or does not have proper labeling, if the medication is to be given over a period of greater than 3 days, if a topical cream/lotion is to be administered for greater than 14 days.
____________________________________________________________________________________________________
Evergreen Media Release Form
Parent/Guardian Signature ___________________________________________
Thank you so much. If you have any questions or concerns, please contact us (334)794-7319
We have several forms on our site that you may want to copy and paste to save in your personal documents. You can print forms such as the Field Trip Permission Form, Medication Administration Form, and Evergreen Media Form. Having access to these documents should make things easier for everyone!
__________________________________________________________
Evergreen Touchstones
Field Trip Permission Form
My child, _________________________ has permission to attend the
field trip to__________________________.
field trip to__________________________.
My child has permission to ride on the Evergreen Bus. ______Yes _____No
My child IS allowed to travel to the above destination in a parent chaperone's vehicle. _____Yes_____NO
I would like to be a chaperone on the field trip with my child______Yes_______No
My child IS allowed to travel to the above destination in a parent chaperone's vehicle. _____Yes_____NO
I would like to be a chaperone on the field trip with my child______Yes_______No
In case of an emergency, please contact:
Name: _________________________________
Phone:______________________________
Phone:______________________________
Parent/Guardian Signature: _________________________________
Date: ________________
Date: ________________
Evergreen Touchstones
Request for Medication Administration
please check ALL that apply
___prescription medication ____refrigeration required___food supplement
___nonprescription medication ___topical product ____modified diet
Name of child:________________________________
Date of birth:_________________________________
Name of Medication:____________________________
Exact Dosage:_________________________________
How many days will this be administered:_____________
Parent/Guardian Signature:_______________________Date:__________
*Time of last dose:________
A licensed physician must complete this form if: The medication requested is not age or weight appropriate, the medication is a sample or does not have proper labeling, if the medication is to be given over a period of greater than 3 days, if a topical cream/lotion is to be administered for greater than 14 days.
____________________________________________________________________________________________________
Evergreen Media Release Form
Parents,
Please complete and return this form indicating your wishes regarding the publication of your child's photo and name on our new web page.
Child's Name:___________________________________________
Date:____________________________________________
Class:___________________________________________
please check:
______I DO give permission for my child to be photographed and for their name to be published on Evergreen's web page.
______I DO NOT give permission for my child to be photographed and for their name to be published on Evergreen's web page.
Parent/Guardian Signature ___________________________________________
Thank you so much. If you have any questions or concerns, please contact us (334)794-7319
Sincerely,
Wanda Barbaree
