MEDICAL RELEASE

In the event I cannot be reached to make arrangements for emergency medical treatment for illness or injury, I hereby authorize the teacher or other qualified persons to take my child to Dr. _________________ Phone #______________ or if not available, to the hospital emergency room.

_________________________________ Parent's Signature Date _________

Remarks:          (special diet, medication, discipline problems, fears, family situation, favorite toy, etc.)

End of Form

Updated Thursday, December 21, 2006