I, the undersigned parent or legal
guardian of above named children will not hold Kaleidoscope,
its agents, servants or employees responsible for any
accidents incurred during participation in the Kaleidoscope
program. If parents or doctor cannot be reached in case of
emergency, consent is hereby given that the student receive
medical treatment and/or surgical care as recommended by
physician or hospital.
Your typed name is considered your
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ANDOVER, MA 01810
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