Church Registration Form Page 3
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3EMERGENCY CONSENT:
It is our policy of to notify a parent when a child is ill or needs medical attention.
Occasionally, we cannot contact a parent 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.
I HEREBY GIVE MY/OUR CONSENT FOR MY/OUR CHILD
______________________________
WHEN ILL/INJURED, TO BE TAKEN TO THE NEAREST EMERGENCY CENTER BY THE
STAFF OF MY CHILD'S DAYCARE WHEN I/WE CANNOT BE CONTACTED. I CONSENT
TO AN AMBULANCE BEING CALLED TO TRANSPORT THE CHILD, IF NECESSARY. I
FURTHER AGREE TO PAY ALL COSTS INCURRED FOR TRANSPORT.
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Parent/Guardian Signature
Parent/Guardian Signature
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Date:
Date:
Please submit forms to:
Sandra Francois
Old First Reformed Church
T: (718) 638-8300
F: (718) 638-0138
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