White Pines Ranch Outdoor Education Center 3581 Pines Rd, Oregon IL 61061 (815-732-7923) Fax (815-732-7924) Emergency Medical Information School: Fairview South School Dates at WPR: September 11 – 13, 2013 Name of Participant_____________________Age____Birthdate______Boy/Girl Address ________________________City ____________ State ___ Zip_____ Name of Parent(s): ______________________________________________ Phone Numbers: Home______________________ Work _______________ Place of Work_____________________________________ In Case of Emergency, Contact: 1. ________________Day Phone____________ Evening Phone___________ 2. __________________Day Phone___________ Evening Phone___________ Family Doctor___________________City____________Phone______________ Date of Last Tetanus Booster Immunization: Month___________Year______ MEDICATION REQUIRED:_________________________________________________________ (Please label medication with name, dosage and time to be taken. All medication should be given to teacher, school administrator or school nurse.) Please allow my child to receive Tylenol and/or Benadryl as needed ____ Any known handicaps or allergies______________________________________ Activities that you would rather not participate in____________________________________ Accident/Medical Insurance Company ___________________ Policy # __________________ Assumption of Risk, Full Release and Indemnity We are cognizant of some dangers of participating in this program. In consideration for allowing the student to participate in activities and use ranch facilities, we assume all risk, agree that no claim will be made against and do fully release Little Sisters, Incorporated, it's officers, owners, employees and agents (the Program) for injury, death, damages or any loss whatsoever incurred and however caused. We hold harmless all Program providers from all claims by us, our family and legal representatives. We assure you the student is in good condition and has no impairment preventing safe participation in the Program. We indemnify the Program from any loss it may incur because of our participation. We know this is a legal agreement and will be broadly interpreted. I hereby give permission for X-rays, suturing of lacerations and other treatment deemed necessary by the attending physician in the Emergency Room. I HAVE THE LEGAL AUTHORITY TO SIGN ON BEHALF OF THE CHILD AND FAMILY. I HAVE READ THIS CAREFULLY AND UNDERSTAND IT. I KNOW THIS IS AS FULL AND COMPLETE A RELEASE AS IS POSSIBLE AND I HAVE SIGNED IT VOLUNTARILY. _____________________________________________
V., Yıldırıma M. M., Journal of Materials Processing Technology 8. “Chromium and Manganese ” http://en.wikipedia.org/wiki/Manga Sajjad Ali, Yaseen Iqbal and Rick Ubic: Manganese Deposits in KPK…… ABSTRACTS (ABSTRACTS OF THE ORAL PRESENTATIONS) 1. The Phase transition behaviour and dielectric properties of Ta2O5- and ZnO-doped BaTiO3 Materials Research Laboratory,
Comprehensive Guide to Interpersonal explaining IPT concepts and issues to pa-cludes with a look at “The Future of IPT” Psychotherapy tients. As an IPT supervisor, I find thatclinicians new to IPT thirst for practical,how- to ways to conduct the therapy. Sug-gested scripts were available in the 1984 Comprehensive Guide more than an up-riches this section as a training manual.