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Health Insurance Information Carrier Policy/Group Number Emergency Authorization In the event of an emergency I hereby authorize GCISD to seek emergency medical assistance for my child. Signature YOUR CHILD WILL NOT BE ALLOWED TO ATTEND THIS FIELD TRIP WITHOUT THE ABOVE SIGNATURE. Revised 1/04. FIELD TRIP EMERGENCY FORM Grapevine-Colleyville Independent School District 2014 KidzU Camps Name Birthdate Sex Age Parent or Guardian Home address Home Telephone Number Work Telephone Number Cell/Emergency Telephone Number Name of Family Physician Phone Current Medications Student is taking Any significant health related information important for teachers to know while your child on this field trip Does you child have asthma Yes No If yes does he/she use an inhaler Please put name of inhaler here. Health Insurance Information Carrier Policy/Group Number Emergency Authorization In the event of an emergency I hereby authorize GCISD to seek emergency medical assistance for my child. FIELD TRIP EMERGENCY FORM Grapevine-Colleyville Independent School District 2014 KidzU Camps Name Birthdate Sex Age Parent or Guardian Home address Home Telephone Number Work Telephone Number Cell/Emergency Telephone Number Name of Family Physician Phone Current Medications Student is taking Any significant health related information important for teachers to know while your child on this field trip Does you child have asthma Yes No If yes does he/she use an inhaler Please put name of inhaler here. Health Insurance Information Carrier Policy/Group Number Emergency Authorization In the event of an emergency I hereby authorize GCISD to seek emergency medical assistance for my child. Signature YOUR CHILD WILL NOT BE ALLOWED TO ATTEND THIS FIELD TRIP WITHOUT THE ABOVE SIGNATURE* Revised 1/04.

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