Monroe First Methodist Church, Inc

Emergency Form

In the event of an illness or accident which requires immediate medical treatment, I give permission for the director and/or staff to authorize such treatment. I will not hold the school responsible for any situations that may occur. I understand that every attempt will be made to contact the parents first, then emergency contacts if the parents cannot be reached.	*
Insurance information (Please include name of insurance, phone number, and policy or group #:	*
Allergies:	*
My child has an Epi-Pen that will be provided	*
Child's Physician:	*
Child's Physician Phone Number:	*
By Typing My Name and Date, I agree to signing this form electronically. I agree to notify the Preschool Director, Stacey Purcell, of any changes or updated information. Parent Name/Electronic Signature:	*
Your Email Address	*