CONSENT FOR EMERGENCY MEDICAL TREATMENT For Events Sponsored by Highland Presbyterian Church 1011 Cherokee Rd. Louisville, KY 40204

Handling of recommendations etc. from each accident investigation committee

Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5. Respite Program:

Jacob s Ladder Pediatric Rehab Center: Respite Program Intake Packet Page 1 of 5 Respite Program: Child s Name #1 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Child s Name #2 Age Birth

Jacob s Ladder Pediatric Rehabilitation Center, Inc. Child Respite Program

Page 1 of 5 Intake Sheet Child s Name #1 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Child s Name #2 Age Birth Date Grade: School: Sex: M F Diagnosis/Disability: Father/Mother/Guardian:

Big House 2015. Cost for the Trip $125 if turned in by March 29th $150 if turned in by April 26th $175 if still space in the camp after April 26th

Cost for the Trip $125 if turned in by March 29th $150 if turned in by April 26th $175 if still space in the camp after April 26th Big House 2015 June 11-14 Bellville, TX Big House is a summer mission

HERZING UNIVERSITY ACADEMIC CALENDAR

HERZING UNIVERSITY ACADEMIC CALENDAR Classes at Herzing University run year-round with breaks as listed below. The calendar at some Herzing University campuses may vary slightly, so please check with your

South East of Process Main Building / 1F. North East of Process Main Building / 1F. At 14:05 April 16, 2011. Sample not collected

At 14:05 April 16, 2011 At 13:55 April 16, 2011 At 14:20 April 16, 2011 ND ND 3.6E-01 ND ND 3.6E-01 1.3E-01 9.1E-02 5.0E-01 ND 3.7E-02 4.5E-01 ND ND 2.2E-02 ND 3.3E-02 4.5E-01 At 11:37 April 17, 2011 At

STUDENT MINISTRY TRIP APPLICATION DAYTON CHRISTIAN SCHOOL SYSTEM R 10/07

STUDENT MINISTRY TRIP APPLICATION DAYTON CHRISTIAN SCHOOL SYSTEM R 10/07 For Office Use Date of submission_reference Forms Parent Pastor Teacher Friend Passport Information: Current Application Name Campus

2015 FUMC Hurst Youth Missions: SAN ANTONIO Permission, Liability Waiver, and Medical Release Form

Permission, Liability Waiver, and Medical Release Form I give permission to participate in activities of the Youth or Children s Division of the First United Methodist Church, Hurst, Texas for the dates

CENTRAL FLORIDA GATOR CLUB SCHOLARSHIP APPLICATION UNIVERSITY OF FLORIDA 2014 APPLICATION YEAR

CENTRAL FLORIDA GATOR CLUB SCHOLARSHIP APPLICATION UNIVERSITY OF FLORIDA 2014 APPLICATION YEAR Congratulations on your acceptance to THE University of Florida! Central Florida Gator Club PO Box 941987

2015 CENTRAL FLORIDA GATOR CLUB SCHOLARSHIP APPLICATION UNIVERSITY OF FLORIDA

2015 CENTRAL FLORIDA GATOR CLUB SCHOLARSHIP APPLICATION UNIVERSITY OF FLORIDA Congratulations on your acceptance to THE University of Florida! The Central Florida Gator Club, an affiliate organization

It s the easiest way to Switch banks!

It s the easiest way to Switch banks! 1. Open a Farmers Bank account at any of our locations. By filling out the following forms, you will help us personalize a deposit account for you. 2. Redirect your

Haven Virtual Academy Application Packet for Online School 2015-2016

Haven Virtual Academy Application Packet for Online School 2015-2016 Haven Virtual Academy (HVA) offers a unique learning environment for students who are eager to learn and are self-motivated. The Kansas

ATHLETIC PARTICIPATION MEDICAL PACKET (SOPHOMORES)

ATHLETIC PARTICIPATION MEDICAL PACKET (SOPHOMORES) Dear Weatherford College Athlete, Athletic Training & Sports Medicine A new year of Weatherford College Athletics is quickly approaching. I hope this

Rowan University s Aim High Science and Technology Academy

s Aim High Science and Technology Academy (residential) Summer Science and Technology Program for Rising Seniors (Current 11th Graders) July 5, 2015 - July 31, 2015 (Sunday-Friday) STUDENT APPLICATION

2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES

2016 FLORISSANT SUMMER PLAYGROUND INFORMATION AND POLICIES CAMP LOCATIONS CAMP DATES/TIMES June 6 July 15, 2016 James J. Eagan Center (300) 9:00am 3:00pm Koch Park (320) No camp July 4th All Prices Subject

Name: Age: Gender: F M DOB: Address: County: Grade:

Registration Due June 1, 2015 4-H Teen Camp - Outer Banks 2015 June 22-25, 2015 Thisexcitingcampforourteen44HmemberswilltakeustothecoastJoinusaswelearnaboutduneecology, marinebiology,northcarolinacoastalhistory,teambuilding,andleadershipskills.activitieswillincludeadolphin

Dymond Speech & Rehab., P.A. Patient Registration Information

Dymond Speech & Rehab., P.A. Patient Registration Information Client s Name: First Middle Last Street Address: Mailing Address: City : State: Zip code: Sex: Marital Status: Home Phone: ( ) - Cell: ( )

REGISTRATION FORMS. Child s Full Name: Birth Date: / / Boy Girl. Child s Full Name: Birth Date: / / Boy Girl

REGISTRATION FORMS Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Child s Full Name: Birth Date: / / Boy Girl Address: City: State: Zip Code: Child #1 Days of the

CHITIMACHA TRIBAL SCHOOL. AFTER SCHOOL CARE PROGRAM Beginning Monday, August 17, 2015 ENROLLMENT PACKET 2015-2016

CHITIMACHA TRIBAL SCHOOL AFTER SCHOOL CARE PROGRAM Beginning Monday, August 17, 2015 ENROLLMENT PACKET 2015-2016 After School Care Program Registration Please read and complete all information contained

Youth Ministry Registration Form. Please complete this form for all children participating in children s ministry.

Youth Ministry Registration Form Please complete this form for all children participating in children s ministry. Last Name First Name DOB Male or Female Parent(s)/Guardian(s): Street Address: City: State:

RARITAN BAY AREA YMCA

Dear Applicant, Enclosed please find the Youth Leaders & Junior Counselor In Training Application and the Camp Registration Packet. Please complete the application and return all documents with your $100.00

TUITION RATES SCHOOL YEAR 2015-2016

TUITION RATES SCHOOL YEAR 2015-2016 REGISTRATION FEE: $65.00 per child DISCOUNTS: Family discount apply to families with two or more children in the Extended Day program. Full price is paid for the youngest

Enrollment Application 2014-2015

Enrollment Application 2014-2015 Student Name: Date: Current Grade Level: Current School: Date of College Track Presentation: Submit Application by: Checklist of items that must be returned to College

FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM

FOOTBALL CAMPS OF AMERICA, LLC CONSENT FORM NOTICE: ALL ATHLETES WILL BE REQUIRED TO HAVE A SIGNED CONSENT FORM BEFORE TAKING THE FIELD. Football Camps of America, LLC. Parental Release Physical Form Waiver

Northern Kentucky University College of Health Professions and St. Elizabeth Healthcare

Northern Kentucky University College of Health Professions and St. Elizabeth Healthcare PATHWAYS TO NURSING SUMMER NURSE CAMP JUNE 25 th 28 th 2012 If you are a high school student who likes people, wants

PCI NVA NSBE, Jr. Pre College Initiative Program

PCI NVA NSBE, Jr. Pre College Initiative Program Nubian Village Academy ational Society of Black Engineers Application Packet NVA-NSBE, Jr. Pre-College Initiative WHAT IS NSBE, JR. PCI? NSBE, Jr.-PCI is

Haven Virtual Academy Application Packet for Online School 2014-2015

Haven Virtual Academy Application Packet for Online School 2014-2015 Haven Virtual Academy (HVA) offers a unique learning environment for students who are eager to learn and are self-motivated. The Kansas

The Winnipeg School Division

PAGE: 1 of 5 1. INTRODUCTION The Board of Trustees of recognizes the importance of providing parents/guardians, students, staff, members of the community and the general public with information about the

CENTRAL MAINE CHRISTIAN ACADEMY 390 Main Street Lewiston, Maine 04240 207.777.0007 www.centralmainechristianacademy.org

CENTRAL MAINE CHRISTIAN ACADEMY 390 Main Street Lewiston, Maine 04240 207.777.0007 www.centralmainechristianacademy.org REGISTRATION FORM (Please Print) STUDENT INFORMATION Student s last name: First:

Instructions for Completing/Updating TFS Online Forms

Instructions for Completing/Updating TFS Online Forms Please use the following instructions to help you enter or update your student and family information online. This information includes important household,

Important Information Please keep this page for your records

Camp Horizon Important Information Please keep this page for your records 1. Complete the enclosed application and the scholarship form thoroughly. Mail them immediately to the camp address listed below.

NORTHWEST PARK & NATURE CENTER Junior Counselor Certification Program 2015

Junior Counselor Certification Program 2015 The Junior Counselor Certification Program (JCCP) is a pre-counselor training program for youth ages 14-17, which focus upon gaining the skills necessary to

CTE SUMMER INTERNSHIP PROGRAM

CTE Applications Due: Thursday, May 15, 2014 PROGRAM DESCRIPTION Learn the both the art of culinary as well as how to develop your own business! This summer experience includes a combination of in-class

Community Health Programs Patient Registration

Community Health Programs Patient Registration Last Name: First Name: Preferred name: Middle Initial: Suffix: Gender: Male Female Former Last Name: Date of Birth: / / Social Security Number: SSN: Mailing

Registration 2012 Summer (Available 7am - 6pm) Child s Full Name: Name Used: Date of Birth: Gender: Grade: Full Address:

ZION CHRISTIAN CHILDREN S CENTER SCHOOL AGE SUMMER CAMP Zion United Methodist Church ~ 1674 Zion Road Troy, VA 22974 (434) 906-5494 ~ ZionUMCAfterschool@gmail.com Registration 2012 Summer (Available 7am

PATIENT INFORMATION SHEET

PATIENT INFORMATION SHEET It is our hope to provide the highest quality of service. Below you will find a patient information sheet which provides our office with useful information that is helpful to

Community Health Programs Patient Registration. Last Name: First Name: Preferred Name: Zip Code: City: State:

Community Health Programs Patient Registration Last Name: First Name: Preferred Name: Middle Initial: Suffix: Former Last Name: Gender: Male Female Date of Birth: / / Social Security Number: Mailing Address:

Application for Childcare

261 Sky River Parkway Monroe, WA 98272 Tel: (360) 794 4775 DSHS Provider #: 827175 Application for Childcare Child s Name: Grade (current/going into): School: Please indicate which program you will be

Address: Street City State Zip Code Home Phone: E-mail Address:

SANDWICH CUSD #430 REGISTRATION FORM SCHOOL YEAR 2013-2014 SELECT AN ATTENDANCE CENTER LG Haskin Prairie View WW Woodbury HE Dummer Middle School High School 1. NAME: 5. SEX: Male Female Last Name First

Christ s Grace compels us to RISK ALL, LOVE ALL to make His name great.

Prospective Youth Leader Letter MDPC Youth Ministry Volunteer Application Driver s Application Volunteer Adult Youth Leader Release Form Copy of Driver s License Copy of Car Insurance Copy of Medical Insurance

PATIENT INFORMATION SHEET

PATIENT INFORMATION SHEET It is our hope to provide the highest quality of service. Below you will find a patient information sheet which provides our office with useful information that is helpful to

Registration Form Penn State Weather Camp June 14 19, 2015 Penn State Advanced Weather Camp June 21 26, 2015

Registration Form Penn State Weather Camp June 14 19, 2015 Penn State Advanced Weather Camp June 21 26, 2015 TO BE COMPLETED BY PARENT OR LEGAL GUARDIAN. Date of Program Please print in ink or type, and

KidsWell School-Based

KidsWell School-Based Health Center ENROLLMENT FORM PLEASE SIGN AND RETURN COMPLETED FORM TO THE SCHOOL NURSE KidsWell School-Based Health Center Exclusively offered inside the following CCSD schools:

Before and After School Enrichment General Information, 2015-2016

Before and After School Enrichment General Information, 2015-2016 Care Site/Title XX Authorization Schools Served Location Times DeWitt YMCA BASE DeWitt DeWitt Elementary 425 Falls Ave Cuyahoga Falls,

MBA Opens Doors Foundation SM Mortgage Assistance Grant Application

MBA Opens Doors Foundation SM Mortgage Assistance Grant Application MBA Opens Doors Foundation sm provides assistance to homeowners with critically or chronically ill or seriously injured children by making

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION

These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we

Cassidy s Cause Therapeutic Riding Academy 6075 Clinton Rd Paducah, KY 42001 270-554-4040

VOLUNTEER / INTERN APPLICATION 2014 Thank you for your interest in volunteering with Cassidy s Cause! Our volunteers are the backbone of our program and without them our riders could not ride. Please complete

Student Board of Directors Application Packet

Dear Student, Thank you for your interest in participating in the Student Board of Directors Program at the Federal Reserve Bank of Kansas City, Denver Branch. Please complete this application packet,

Initial. Registration Packet. Summer Academy June 3 rd to August 30 th Z M G. www.zmgtennis.com. HP and TTT Registration Form 1 ZMG Tennis, LLC

Registration Packet Summer Academy June 3 rd to August 30 th Z M G www.zmgtennis.com HP and TTT Registration Form 1, LLC Enrolment Process prides its self on offering everything essential in the development

The scholarship awards are merit based with the eligibility as follows:

COVER PAGE The Judy Moore Memorial Scholarship Endowment A NC Community Foundation Scholarship (A scholarship made available for registered nurse students.) 2016 The Judy Moore Memorial Scholarship Endowment

Transitions Intake Form

Transitions Intake Form Please fill out completely. If you have any question about the program please use the contact below. Lisa Thomas Transitions Coordinator lthomas@communityhaven.com Katie Auer Transition

Eastern Region Youth Consultant Salem, Virginia 24153 jaharden@comcast.net 540 375-3191

UNITY WORLDWIDE MINISTRIES EASTERN REGION Jane Harden 1865 Laurel Mountain Dr Eastern Region Youth Consultant Salem, Virginia 24153 jaharden@comcast.net 540 375-3191 December 16, 2014 Dear Y.O.U. Sponsors,

Brentwood School District

Brentwood School District Dear Families, It is a pleasure to welcome you to kindergarten and to the Brentwood School District! Our commitment is to grow capable learners and inspire lifetime leaders. We

Laurel Heights UMC Weekday School 234 W. Mistletoe San Antonio, Texas 78212. 210-732-6979 Fax 210-732-6392 APPLICATION FOR ADMISSION

Laurel Heights UMC Weekday School 234 W. Mistletoe San Antonio, Texas 78212 210-732-6979 Fax 210-732-6392 APPLICATION FOR ADMISSION Child s name (last) (first) (middle) (name used) Sex Date of birth Place

PEMBROKE PINES CHARTER ELEMENTARY/MIDDLE SCHOOL CENTRAL & WEST AFTER SCHOOL CARE PROGRAM 2013/2014

Dedicated to providing a high quality education to a diverse community where all students are expected to succeed as life-long learners. PEMBROKE PINES CHARTER ELEMENTARY/MIDDLE SCHOOL CENTRAL & WEST AFTER

THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP

THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP 2011 SUMMER FASHION PROGRAM STUDENT APPLICATION CHECKLIST To apply for the Summer Fashion Program, please submit the required documents to The Center for Global

*Registration* *Permission Form* *Student Essay* *Covenant*

2015-2016 1 st YEAR CONFIRMATION REGISTRATION PACKET *Registration* *Permission Form* *Student Essay* *Covenant* Student full name: Address: Birth Date: Date of Baptism: Place (Town, State) Place (Church)

Please be advised that monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments.

Brick Township Public Schools Brick Extended School Time Before and After School Care & Kindergarten Wrap Around 224 Chambers Bridge Rd - Brick, NJ 08723-732-262-2590 ext. 1531 BEST Program Families: Thank

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition.

California Polytechnic State University, Pomona Vietnamese Student Association Family. Honor. Tradition. ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM Name of Activity or Event: CAL POLY POMONA VSA WINTER

DELEGATE APPLICATION June 16 June 19, 2014 Riverside Presbyterian Church 849 Park Street Jacksonville, FL 32204

Metrotown Institute DELEGATE APPLICATION June 16 June 19, 2014 Riverside Presbyterian Church 849 Park Street Jacksonville, FL 32204 What is Metrotown Institute? The OneJax Metrotown Institute is a gathering

8 Wakeman Rd Fairfield, CT 06824 (203) 255-5078

Southern Connecticut Christian Counseling Center, Inc. dba R E N E W C O U N S E L I N G A S S O C I A T E S Christian therapists committed to serving you, your family, and your community 8 Wakeman Rd

2015 Nature Explorers Registration Form (Rising 1st to 3rd graders)

Information 2015 Nature Explorers Registration Form (Rising 1st to 3rd graders) Camper Name: DOB: Parent/Guardian Name(s): Address: City: State: Zip: Home Cell Work Email: *If emergency contact is different

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823

Hornets Youth Enrichment Summer Program 1200 North DuPont Highway Dover, Delaware 19901 Telephone: 302-857-6824 Fax: 302-857-6823 Participant Last Name: Participant First Name: Grade: Age: Gender: Male

ATTENTION STUDENTS! and must be able to commit to the full course schedule.

ATTENTION STUDENTS! I ncludes College Trip, College Prep Workshops AND SAT Prep Course. Friday, January 25 th through Saturday, March 23 rd 2012. Sponsored by the EDUCATIONAL TALENT SEARCH PROGRAM at JOHN

COMMUNITY FOR NEW DIRECTION PARTICIPANT REGISTRATION FORM

COMMUNITY FOR NEW DIRECTION PARTICIPANT REGISTRATION FORM Child s Name (Last) (First) (Middle Init.) Address Apt. # Zip Code Home Telephone Message Telephone Birth Age *Gender: Male Female *Race (please

Community House High School Programs Standing with families since 1969

Dear Parents/Guardians, Founded in 1969, Community House is devoted to standing with Princeton families by providing tools for academic success and social- emotional wellness through programs that bolster

Date: Student s Name DOB / / Age!!! (First)!! (Middle)!! (Last) Preferred name. Student s School Grade Level Dismissal Time

Lafayette Theatre Academy Registration Form Date: Student s Name DOB / / Age!!! (First)!! (Middle)!! (Last) Preferred name Student s School Grade Level Dismissal Time Parent/Guardian/Account Holder s Information

Southeast Unity Youth Ministry Minister Endorsement Form

Minister Endorsement Form Program: UNITEENS Retreat Lock-In List all Youth and Adults below who are attending this SE Unity Youth Event. Once submitted, substitutions and additions must be approved by

ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA NURSING SCHOLARSHIP

ALUMNI ASSOCIATION OF THE SCHOOL OF NURSING OF THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA NURSING SCHOLARSHIP The Alumni Association of the School of Nursing of the Hospital of the University of Pennsylvania

Kentucky District Junior Leadership Training Academy Rotary Ranger Reservation Glasgow Kentucky

Kentucky District Junior Leadership Training Academy Rotary Ranger Reservation Glasgow Kentucky FOR OFFICE US E POSTMARKED: PAID: BALANCE DUE: Please select the camp you are attending by checking the correct

UConn First Star Academy 2015 Application Checklist

Student's Name: Social Worker: Area Office: Phone #: UConn First Star Academy 2015 Application Checklist Please use this checklist to make sure the application is complete: 1. Student Application 2. DCF

J UNE 15 - AUGUST 7 GRADES (going into) HEADSTART - 7th grade

J UNE 15 - AUGUST 7 GRADES (going into) HEADSTART - 7th grade Our day camp offers structured activities from 8:00 a.m. to 5:00 p.m., 5 days a week for an eight-week program, all at one low price. Children

SUMMER COACH APPLICATIONS DUE APRIL 30

Summer 2015 Hi Reading Coach! The Team Read Summer Program is an excellent way for current and former Team Read tutors to stay involved with not only Team Read, but also the Seattle Public Library and

CONTRACT. Southwest Tour. Arkansas and Texas

27 th Annual Tour CONTRACT Southwest Tour Arkansas and Texas APRIL 3 rd April 10, 2016 COLLEGES and UNIVERSITIES (Tentative) Arkansas Baptist College, Huston-Tillotson University, Jarvis Christian College,

Kevin A. Williams Coordinator. 108 Washington Street P.O. Box 1724 Cumberland, MD 21501-1724 Telephone (301) 759-2000 www.acps.allconet.

108 Washington Street P.O. Box 1724 Cumberland, MD 21501-1724 Telephone (301) 759-2000 www.acps.allconet.org August 21, 2013 Dear Parent or Guardian, Welcome to the 2013-2014 school year! Once again, Washington

Educational Talent Search

Dear Parent(s), Educational Talent Search (ETS) is a project funded by the U. S. Department of Education and is administered by Diablo Valley College (DVC). The purpose of this project is to encourage

Extended Enrichment Kindergarten Program at YOUR Home School!

Extended Enrichment Kindergarten Program at YOUR Home School! QUALITY CARE AT YOUR NEIGHBORHOOD SCHOOL ENRICH your child s early educational experience by EXTENDING his or her learning and fun right at

SOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET

SOUTHWEST OHIO INLINE HOCKEY PLAYER DOCUMENTATION COVERSHEET School / Team: Name: Address: City, State, Zip: Home Phone: Cell Phone: Email: (please circle your responses) Do you attend the above named

Spina Bifida Association of Kentucky Grant Application

Spina Bifida Association of Kentucky Grant Application SBAK Grant Fund General Guidelines Through this application process, a designated committee will responsible for the approval or denial of the request.

GCA Summer Camp 2016 Overview

GCA Summer Camp 2016 Overview Ages: Preschool to 6th Grade Registration Fee: FREE if registered by May 2nd; $15 per week if registered after May 2nd. Tuition Fee: $125 per weekly session.* This includes

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms All forms and payment are due no later than June 15, 2015 Note: There is a $25 non-refundable registration fee, and no refunds

Mathematical Logic: From Puzzles to Infinities FOR ADVANCED MIDDLE AND HIGH SCHOOL STUDENTS Day Enrichment Program Summer 2014

Mathematical Logic: From Puzzles to Infinities FOR ADVANCED MIDDLE AND HIGH SCHOOL STUDENTS Day Enrichment Program This two week day enrichment program on the campus of Rensselaer Polytechnic Institute

Part 1: To be completed by Parent/Guardian. Please Print Clearly. Home Address. City ST ZIP. Mother s/legal Guardian name

Cool Kids Campaign Program Application/ Information/Release The Cool Kids Campaign Foundation provides programs to children living with cancer. The mission of the Cool Kids Campaign is to provide kids

Tampa Bay Performing Arts Academy

Tampa Bay Performing Arts Academy Musical Theater Disney Cinderella KIDS Sound of Music Disney s Lion King JR Dance Tap Broadway Dance Adv. Jazz Jr Broadway Jazz & Tap Private Voice Broadway Classical

2015-16 Insurance Information Insurance coverage

2015-16 Insurance Information Insurance coverage At USA Wrestling, our top priorities are safety and security. That's why we make sure you're covered by General Liability, Accidental Medical Expense, and

Oberlin Dance Intensive

Oberlin Dance Intensive July 6-11, 2014 For Ages 14-18 Early Registration Deadline: March 1, 2014 = $585 tuition Regular Registration Deadline: April 10, 2014 = $625 tuition Email completed registration

Individuals wanting to purchase a car through this program must meet the following qualifications:

Tier II Program Individuals wanting to purchase a car through this program must meet the following qualifications: You must have a verifiable job offer or be working at least 30 hours a week. If enrolled

Dymond Speech & Rehab., P.A. Patient Registration Information

Dymond Speech & Rehab., P.A. Patient Registration Information Client s Name: First Middle Last Street Address: Mailing Address: City : State: Zip code: Sex: Home Phone: ( ) - Cell: ( ) - Other: ( ) - of

TREATMENT PLAN DOMAINS: For each goal, please complete each of the following domains:

Section 24 Provider Agency: Date of Individual Treatment Plan: DOB: Age: TREATMENT PLAN DOMAINS: For each goal, please complete each of the following domains: Describe what the child will do in observable

Youth and Family Ministries Policy for the Protection of Children

Youth and Family Ministries Policy for the Protection of Children Statement of Purpose The church is called to be a life-giving communion of worship, renewal, and discipleship. This is equally true for

Application for the 2016 High School Law Camp June 13th, 2016 July 1st, 2016

Application for the 2016 High School Law Camp June 13th, 2016 July 1st, 2016 Sponsored by The Law School Preparation Institute at The University of Texas at El Paso LSPI HSLC Coordinator Alejandra Hobbs

Basic Application. Excel Leaders Program Fall 2015. Last First Middle. City State ZIP Code. City State Month/Day/Year

APPLICATION FOR EXCEL LEADERS AT THE UNIVERSITY OF MEMPHIS Excel Leaders Overview Excel Leaders is a Christian urban leadership development and student success program at The University of Memphis with

Mindful Health Advantage, LLC

8015 West Alameda Ave., Ste 230, Lakewood, CO 80226 - - - CLIENT ADDRESS, CONTACT & FUNDING INFORMATION - - { CLIENT INFORMATION } Last Name First Name M.I. Date of Birth Ethnicity How did you hear about

WATERVLIET CIVIC CENTER BEFORE & AFTER SCHOOL PROGRAM SCHOOL-AGE CHILD CARE PROGRAM 2015-2016 APPLICATION. D.O.B. SEX: GRADE (in Sept.

WATERVLIET CIVIC CENTER BEFORE & AFTER SCHOOL PROGRAM SCHOOL-AGE CHILD CARE PROGRAM 2015-2016 APPLICATION CHILD NAME: ADDRESS: CITY: D.O.B. SEX: GRADE (in Sept. 2015): MOTHER S NAME: ADDRESS: CITY: STATE:

Individualized Healthcare Plan (IHP) Core Form

Individualized Healthcare Plan (IHP) Core Form An Individualized Healthcare Plan (IHP) should be developed by the parents/guardian, school nurse, student and other pertinent school officials. This plan

CHALLENGER WORLD TOURS (CWT)

CHALLENGER WORLD TOURS (CWT) TRAVELER REGISTRATION DOCUMENT & TERMS AND CONDITIONS Mail, Fax or Scan/Email To: Challenger World Tours Attn: Gareth Hughes 8263 Flint, Lenexa, KS 66214 USA Phone: 800 878

Baylor Autism Resource Center Applied Behavior Analysis (ABA) Therapy Program

Baylor Autism Resource Center Applied Behavior Analysis (ABA) Therapy Program Please see the enclosed information and application for more information. The Baylor Autism Resource Center (BARC) Applied

Multimedia Contest Guidelines Spring 2015

Multimedia Contest Guidelines Spring 2015 Multimedia Contest Rulebook 1 Dear School Administrators: Thank you for your willingness to participate in Kids Voting USA-Brownsville (KVUSA-B). As you know,

JUNE 20 24, 2016 VIDEO GAME DEVELOPMENT SUMMER CAMP

Attention upcoming 7 th - 10 th graders: You are invited to join the IT and Web Design faculty at Carteret Community College for an action packed week of Video Game Design, Development, and Play. JUNE

CSUN Rebel Road Trip 2015 UNLV vs. SJSU

CSUN Rebel Road Trip 2015 UNLV vs. SJSU Represent the UNLV Rebellion in San Jose, CA for the UNLV Runnin Rebels vs. SJSU Spartans. This is the final regular season basketball game of the year and we need