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Meadowlane Nursery School
 Call us at: 402-486-1414


     CONSENT TO CONTACT PHYSICIAN IN EMERGENCY

       In the event that I cannot be reached to make arrangements, I hereby give my consent to 
       Meadowlane Nursery School to contact 


        Dr. _________________________________ at ____________________(phone number).  

        In addition, if necessary, take my child to the following doctor(s), clinics or hospitals:





                                                 _______________________________________    ____________________
                                                   Parent Signature                                                      Date












      FIELD TRIP PERMISSION

      I give permission for my child to ride in a private vehicle with proper safety restraining devices 
      during the 2018-2019 school year. 




                                                 ___________________________________      ________________
                                                   Parent Signature                                                        Date


         Please list any exceptions:









2018-2019