Emergency Medical Treatment

Emergency Medical Treatment Authorization

Permission for medical care in parental absence.
By completing this form, I, parent or guardian of the child named above give my permission to Kessel Kids Child Care & Learning Center, child care provider, to secure and authorize such emergency medical care and treatment as my child might require while under the Provider's supervision. I also authorize the Provider to administer emergency care or treatment as required, until emergency medical assistance arrives. I also agree to pay all the costs and fees contingent on any emergency medical care and treatment for my child as secured or authorized under this consent. as required, until emergency medical assistance arrives. I also agree to pay all the costs and fees contingent on any emergency medical care and treatment for my child as secured or authorized under this consent.
NOTE: Every effort will be made to notify parents immediately in case of emergency. In the event of an emergency, it would be necessary to have the following information:

Parent or Legal Guardian (1)


Parent or Legal Guardian (2)

Doctor

Preferred Hospital

Dentist

Emergency Contacts

Persons to be contacted during emergency if the parents are unavailable:

Medications, Allergeries & Vaccinations

Agreement