Please call us at:
(513)563-SAVE or fill out our contact form.
Precious Life Center
11406 Reading Rd
Sharonville, OH 45241
Precious Life Home
710 Oakleaf Drive
Dayton, Ohio, 45417
Phone :(937)830-0157
Precious life Services
245 W. Elmwood Dr #207
Dayton, OH 45458
Phone:(937)830-2101
PLC Transportation
6100 Oak Tree Blvd
suite 200
Cleveland, OH 44131
(216)328-2120
PLC Ghana:
682 Anokye Rd
Bantama, Kumasi
Ghana, West Africa
233200087294
The Next Campaign to End Hunger! For information on how to participate, please contact us.
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All Cash or Check donations can be made payable to Precious Life Center, PNC Bank AB#041000124 A/C# 4259595806.
Thank you for your support!!!
DONATE NOW!
Monthly Gift
As a monthly donor of $10 or more, you will receive a handmade bracelet made from our teen moms from Ghana, and periodic updates on our programs in
Ghana you support!
Have a question?
If you prefer to give your donation information over the phone, call us anytime
at 5135637283.
Precious Life Center
Program12yrs and up
Please Print Clearly and Return to the Center Office ASAP.
Child’s Name (One Form Per individual:
Date of Birth:
Age as of 6/2014:
Grade Entering:
Allergies or Medical Concerns? : ________________________________________________ Parent/Guardian Name(s): Address:
City:
State:
Zip:
Phone #:
Secondary Phone #: Email Address: Emergency Contact Name: Phone #:
How did you hear about PLC’s Program:
Homecare agency:
EMERGENCY INFORMATION AND MEDICAL AUTHORIZATION
Purpose of the following information: To enable parents and guardians to authorize the provision of emergency treatment for individual who become ill or injured while under center authority, when parents or guardians cannot be reached. FILL OUT ONLY PART I or PART II.
PART I – GRANT TO CONSENT
In the event reasonable attempts to contact me at (phone #) have been unsuccessful, I
hereby give my consent for: (1) The administration of any medical treatment deemed necessary by (physician)
Dr. at phone #_ or (Dentist) Dr. at phone # , or in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child/ family member to (preferred hospital) or any other hospital reasonably accessible.
This authorization does not cover major surgery unless the medication opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.
Facts concerning the child’s/ family member’s medical history including allergies, medications being taken and
any physical impairments to which a physician should be alerted:
Parent/Guardian Signature:
Date
PART II – REFUSAL TO CONSENT
I do not give my consent for emergency medical treatment for my child/ family member. In the event of
illness or injury requiring emergency medical
treatment, I wish the PLC authorities to take no action
but to do the following:
Parent/Guardian Signature:
Date
*Please note that your child/ family may be Photographed for publicity purposes.
*ALL Instruments needed for the program must be provide by individual
11406 Reading Rd
Sharonville, OH 45246
Phone: (513)563-7283
Fax: (513)563-1234