T-shirt size

Student's Name	Julian Wolfgang Taylor
Date Of Birth	08/29/2017
T shirt size	Child S
PARENT INFORMATION
Parent 1	Ashton Taylor
Cell Phone	(919) 259-8993
Home/Work Phone	(919) 259-8993
Parent 2	Julians Taylor
Cell Phone	(919) 200-5025
Emergency Contact 1	Sumaya Selma
Relationship	Wolfie's Stepmother
Phone Number	(910) 574-3051
Emergency Contact 2	Anderson Taylor
Relationship	Wolfie's Grandfather
Phone Number	(336) 407-9999
ALLERGY INFORMATION
Does this child have any known allergies?	No
OTHER MEDICAL INFORMATION
Current Medications and Dosages	None
Please list any significant medical information including chronic illnesses, injuries, physical limitations, and any diagnoses this child has received.	None
Will your child need the learning environment or assignments adapted in any way?	No
What other information will help us to provide a safe and accessible environment for your child?	Wolfie is very healthy and brave.
Insurance
Name of Policy Holder	none none
Employer	none
Insurance Company	none
Policy Number	none
SIGNATURE	I, as parent or legal guardian, do hereby grant Deerstream faculty and trustees present the right to authorize emergency medical treatment for my child, named above, in the event that my designated representatie or I cannot be reached. I agree to hold harmless Deerstream and its agents from liability arising out of accident situations. The North Carolina Good Samaritan Law will apply.
Name	Ashton Taylor
Signature