Precious Life Center, Ohio
Precious Life Center, Ohio

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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

211 Fountain Ave

Dayton, Ohio, 45406

Phone :(937)626-6668

 

PLC Adult Day Program

2166N Gettysburg Ave

Dayton, OH 45406

Phone:(937)281-0154

 

precious Life Services

6100 Oak Tree Blvd

suite 200

Cleveland, OH 44131

(216)328-2120

 

Ghana:

682 Anokye Rd

Bantama, Kumasi

Ghana, West Africa

P.O Box ks11492

 

Phone: 011233277889993

 

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 childs/ 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

 

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