Medical Consent Form
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1THE GERRARD RESOURCE CENTRE ______________________________________________________
350 Victoria St. KHW 383A, Toronto Ontario, M5B 2K3
TEL: 416-979-5000 x2535, FAX: 416-979-5239
M
C
F
EDICAL
ONSENT
ORM
I, _______________________________________ give my permission for my child,
_________________________________________ to be taken to the hospital in case of emergency when I am
not immediately available and to receive any necessary medical treatment.
D
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P
S
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ATE
ARENT
IGNATURE
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I understand that the Gerrard Resource Centre will use the personal information collected on this form for the purpose of
communicating with me from time to time about programs, services, fundraising activities, and changes in policy and I
consent to the use of my information for this purpose. I understand that I can withdraw this consent at any time by writing the
Gerrard Resource Centre at 350 Victoria St. Toronto, Ontario M5B 2K3 or emailing at
cmoher@ryerson.ca
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