Emergency Form
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  * 
Online Giving Powered by SiteOrganic Giving