PERMISSION AND CONSENT FORM:

I give permission for Crystal Arnold to

Administer over the counter medication ______

with my written instruction:

Take my child on walks in the neighbourhood ______

Including to parks and the Early Years Centre:

To occasionally take my child in a vehicle with ______

Proper Restraints

To take my child into a backyard kiddie pool: ______

To take photos of my child and display my

Child’s art work: ______

To assist with Potty Training: ______

Childs Name: _______________________________

Parents Signature: _____________________________

Date: ________________________