When parents cannot be reached, list at least one person who may be contacted to pick up the child in an emergency:
In EMERGENCIES requiring immediate medical attention, your child will be taken to the NEAREST HOSPITAL EMERGENCY ROOM. Your signature authorizes the responsible person at the child care facility to have your child transported to that hospital.
INSTRUCTIONS TO PARENTS
(1) Complete the following items, as appropriate, if your child has a condition(s) which might require emergency medical care.
(2) If necessary, have your child’s health practitioner review the information you provide below and sign and date where indicated.
EMERGENCY MEDICAL INSTRUCTIONS
Note to Health Practitioner
If you have reviewed the above information, please complete the following: