Summer Safety Registration

Child's Name *

First

Last

Child's Age

Address

Address Line 1

City

State

Zip Code

Please list any medical history and medications:

Please list any allergies:

My child will be(choose one):

Parent or Guardian contact information: *

First

Last

Phone Number(s)

Who do we contact in case of an emergency?

Phone number(s)

Please read and check all the boxes to indicate you understand and agree to the following:

I give my child permission to participate. I understand my child can get hurt at any time during class, activities and/or walking to and from home (if child is walking) Tubac Fire will not be liable if my child sustains any injuries. My child can eat what is provided for snacks (I have included any food allergies).
I have been provided with classroom/activities information and Tubac Fire’s contact information.
I give Tubac fire permission for my child to be in any picture/video public media release.
In case of an emergency if the guardian or emergency contact are not reachable, I give Tubac Fire permission to transport to nearest hospital via ambulance. Tubac Fire will not be responsible for any medical bills including transport.

By submitting this online registration I agree to all the above:

Name of responsible party

Carmen Hernandez, FF/CEP Public Educator Work: 520-398-2255 Cell: 520-404-7559 [email protected]

Phone