If "Yes", please list all allergies or sensitivities:
Mother's Information (or Guardian)
Father's Information (or Guardian)
Below please list the names of the persons authorized to pickup your child. Your
child will not be released to others without your permission. You may also authorize an
individual for a particular day by placing their name on the daily sign‐in sheet.
Please advise designated persons to have proper identification available. If an
emergency arises you can call the Destiny Church office at (952) 890-1477 and give
verbal permission to release your child to an individual.
Medical Treatment Agreement: In case of an accident or illness, if I (we), the parent(s) or guardian(s), are not
available, my (our) child should receive medical treatment by Destiny personnel, by
his/her doctor, or by personnel of a hospital emergency room.
Permission to Administer
I hereby give Destiny Kids Time permission to administer the following products according to the manufacturer's instructions or otherwise specified.
NOTE: Destiny Kids Time worker will use his/her best judgement as situations arise, and if in doubt, he/she will call for verification.