Parental Information

Child's Information

Child's Medical Information

• In case of emergency and I am unable to be reached, I authorize medical treatment to be given to my child by a licensed medical professional. This authorization includes any necessary tests, procedures, or medications that the medical professional deems necessary for the treatment of my child's medical condition.
• I understand that the medical professional will make every effort to contact me or the emergency contact listed above prior to administering any medical treatment to my child, unless it is determined that immediate treatment is required.
• I certify that my child is not allergic to any medications and does not have any medical conditions that would prevent him/her from receiving medical treatment.
• I understand that this consent form will remain in effect until revoked by me in writing.