Welcome to Independence Academy Please review all linked documents and complete all sections. Child Medical Information Child's Name(Required) First Last Any Known Allergies:(Required) Treatment: Health Limitations: Emergency Medications: Daily Medications: Any Other Health Information You Think We Should Know: *If health information changes, please inform the director and the child’s teacher as soon as possible. Additional forms for medication, including emergency medication, are required. Acknowledgements and Permissions I have read the IA Photography Waiver Information below. IA Photography Waiver Please select one:(Required) I do allow my child to be photographed I do not allow my child to be photographed For children to participate in nature walks, visit the outdoor classroom, and participate in specials events such as trunk or treat, permission must be given to play outside the fenced area. Enrollment in all Inde Nature School programs requires permission to play outside the fence. Please select one:(Required) I do give permission for my child to play outside the fenced area I do not give permission for my child to play outside the fenced area I have read the Assumption of Risk, Release, and Indemnity Information below. Assumption of Risk, Release, and Indemnity Payment will be made monthly via Quickbooks invoices. Please indicate below whether you will be paying via ACH Bank Transfer or Check.(Required) ACH Bank Transfer (1% Processing Fee) made online Check (no Processing Fee) placed into DropBox outside of Office Door Credit/Debit Card (3% Processing Fee) made in person at The Inde Nature School Office The below is an electronic signature. By typing your name and the date, you agree that you have read all above information.(Required) I agree Name(Required) First Last Date(Required) MM slash DD slash YYYY
