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<br />Career and Technical Education Career Academy Summer Registration <br />Form <br />Name Grade <br />Address Home Phone <br />City ~ Zip <br />Gender <br />School <br />Where parents can be reached if not home: <br />Mother's Name ~ Work Tel. <br />F'ather's Name <br />Work Tel. <br />Emergency Information <br />List two neighbors or nearby relatives to contact in case of an emergency if you cannot be reached. <br />Name <br />Tel. <br />Name Tel. <br />Doctor or Clinic Name <br />Office # <br />Hospital Preference <br />List Allergies or other Health Conditions <br />Medication taken daily <br />*Please call and give me advice and send a written note if your child is on a daily medication* <br />Other Important Medical Information <br />You or your emergency contact will be called and notified first in case of an accident or serious illness. <br />If neither of us can be reached I hereby authorize school personnel to take or send my child to the , <br />family physician or to the hospital that I have requested. We will continue to call you. <br />Parent/Guardian Signature Date <br />Fax or mail the registration form to Geraline Graham-Young at Cedar Ridge High School, <br />1125 New Grady Brown School Road, Hillsborough, NC 27278 <br />Fax: 919-245 - 4012 <br />For additional registration information contact Geraline Graham-Young (919) 245-4003, ext. 2 <br />E-mail: ~eraline.graham(a~oran~e.kl2.nc.us <br />7 <br />