Emergency Medical Form

Emergency Medical Authorizations
 

This form must be completed on a yearly basis and updated throughout the year as contact information changes.

 

Click here for Emergency Medical Form

Name & Address

The top portion of this form provides us with information to update your child’s address in our computer system. 

Non-Resident Parent Information

 

Contact Info

The information in the section allows us to contact you during the day and is utilized as a list of persons eligible to pick up your student in case of illness or injury.

 

PART 1-Consent for Treatment

This portion allows access to your doctor and dentist during an emergency.

 

Medical Information

This portion allows emergency services and pertinent school personnel to be aware of child’s medical background.

 

Consent

This section is signed to enable emergency services to provide care if the parents are unable to be contacted.

 

PART 2-Refusal of Consent

This part is utilized by signing when consent is not given for medical treatment.