NOTE: THIS ENTIRE FORM MUST BE UPDATED ANNUALLY. INSTRUCTIONS TO PARENTS: (1) Complete all items on this form. Sign and date where indicated. (2) If your child has a medical condition which might require emergency medical care, please note at the bottom of the page. If necessary, have your child’s health practitioner review that information.
In EMERGENCIES requiring immediate medical attention, 911 will be called and your child will be taken to the NEAREST HOSPITAL EMERGENCY ROOM by an ambulance. Your signature authorizes the responsible person at the child care facility to have your child transported to that hospital.