Preschool Permission and Release Form

Child's Name*

First Last

Nickname (if any)	Birth Date

Parent/ Guardian Name(s)*

My Child Has:*

NO KNOWN allergies, medical needs, or dietary restrictions.
medical needs or severe allergies that require an Individual Care Plan. (i.e. asthma)
food intolerances or special dietary needs.

Please describe limitations, care required or appropriate response for any conditions specified above:

Permission to Alert Staff*

By clicking the box above, I agree to allow Dodge Nature Preschool to post a small photo of my child in the classroom and food preparation areas to alert staff to my child's dietary or medical needs.

If your child has a severe or life-threatening allergy or medical condition, please contact the office staff at 651-455-4555 for a supplemental Individual Care Plan to be completed by your Health Care Provider.*

I will contact the staff for emergency medical paperwork.

I understand that any special food for my child that is not usually supplied by the school will be provided by my family for school use.

Dodge Nature Preschool tries to provide many healthy options for snacks, including gluten-free, nut-free, dairy-free options, etc.

I will provide special food, if needed.

Medication Release

Families should apply sunscreen and insect repellant before bringing children into Dodge Nature Preschool (when necessary in the spring, summer and fall seasons).

I give permission for the staff of Dodge Nature Preschool to reapply additional sunscreen and insect repellant to my child, as needed.*

Agree (Sunscreen/Bug Spray)
Do Not Agree (Sunscreen/Bug Spray)

Please explain:

I understand that Dodge Nature Preschool must have a prescription and written instructions from a doctor to administer prescription medication or written parental consent for over-the-counter medications.*

Agree (Medication)

Information/ Publication Release

I give my permission for my child's name and family contact information (email, phone, address) to be listed in a school directory distributed to his/her class.*

*Directories are only provided during the school year.

Yes, Include all directory information
No, Remove us from classroom directory
Limited Directory Permissions (specify below)

Specify

At Dodge Nature Preschool, we use photographs of children to share with families about our day, to illustrate information in our educational publications, and to share the wonder of Dodge Nature Preschool with the public.*

We do not use children's names when we share photos with the public.

I give permission for my child's image to be used for these educational or promotional purposes.
I do NOT want my child's image to be used in/on: (please specify below)

Specify

Field Trip Permission*

I understand that my child will regularly participate in walking field trips on the grounds and to the buildings of Dodge Nature Center, including classrooms in the Farm Education Building (1701 Charlton St.).

Agree (Field Trip)

Permission & Signature*

I have read carefully and understand the information on this form. I have indicated my consent and authorization where applicable.

Please Enter Your Full Name*

Date*

Email

If you would like an email confirmation of this form, please enter your email address here.

About Camps

Scholarships

Blacksmithing Basics 1 with Coal Forge (8-session Series)

Sept. 26th - Oct. 10th

Girls Explore Science: Autumn Assortment

Sept. 27th - Oct. 25th

Pride Outside: Fall Festivities

Sept. 28th - Nov. 9th

Preschool Permission and Release Form

Form #2 - Preschool Permission and Release Form

Medication Release

Information/ Publication Release

About Camps

Scholarships

Blacksmithing Basics 1 with Coal Forge (8-session Series)

Sept. 26th - Oct. 10th

Girls Explore Science: Autumn Assortment

Sept. 27th - Oct. 25th

Pride Outside: Fall Festivities

Sept. 28th - Nov. 9th

Preschool Permission and Release Form

Form #2 - Preschool Permission and Release Form

Medication Release

Information/ Publication Release

Stay connected to Dodge by joining our mailing list

Search Dodge Nature Center