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<br />Chain 01 Lakes YMCA Summer Programs
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<br />"'Id 1""1i II Chain of L,kes YMCA . 7690 Viii,S. Drive . Lina Lakes, MN 55014 . Phone; 651'795-9622 . fox: 65]-784.7135
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<br />PL&IS[ USE OIlE fOR//, PfP CHILD ,NO PRIIIT NfATl1
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<br />EMERGENCY CONT~CTS AND PICK-UP AUTHORIZATION
<br />The following people should be contacted in case of emergency, only if parent or
<br />guardian connol be reoched AND are authorized to pick up the child:
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<br />15 THE CHILD TAKING ANY MeDICATIONS? _ I ie, LJ lie
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<br />If medication needs to be administered during the program, 0 Medication Permission
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<br />liAS CHILD HAD ANY Of TKE fOLLOWING, AND If SO, PLEASE EXPLAIN,
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<br />SIGNlfJ~ANT INFORMATION ABOUT YOUR CKILD'5BEHAVIOR THAT
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