EMERGENCY CONSENT FORM
It is the policy of the Centre to notify a parent when a child is ill or needs medical attention. Occasionally we cannot contact parents and we need to get immediate help for the child. Our procedure is to take the child to the nearest emergency service.
Please sign below so that we can take appropriate action on behalf of your child. Return the signed card to the Centre immediately.
I hereby give consent for my child
to the nearest emergency center by the staff of
Centre when I cannot be contacted. I consent to an ambulance being called to
transport the child, if necessary.
Provided by Richmond Health Services, CCFL	09/05
Phone:
Bus:
Phone:
Bus:
Phone: (    )
Phone:
when ill to be taken
Cherry Blossom Montessori Preschool
EMERGENCY INFORMATION
Child's Dentist:
Medications:
Medical Conditions/Allergies:
Phone:
Date
Signature of Parent/Guardian
Child's Name:
Birthdate:
Address:
Parent Name:
Phone:
Bus:
Parent Name:
Emergency Contact:
Out of Province Emergency Contact:
Child's Physician:
Date of Most Recent Tetanus Shot:
Care Card No.: