Preschool Registration Form (Page 4 of 4) in pdf

MEI Preschool --- Immunization Record /

Emergency Consent Form

Child’s name: _________________________ Date of Birth:_________________

Complete (child has all recommended immunizations)

Incomplete

If incomplete or unknown immunization status:

If incomplete last immunization received _________________________________

Exempt -

We have chosen to exempt our child from the recommended immunizations. If

exempt, please sign an exempt form, available at the MEI Elementary School Office

Emergency Consent Form

1. If your child sustains a minor injury while in our care, we will provide First Aid Treatment. We will

report the incident to you upon arrival and depending upon the treatment, a minor incident form

may require your signature.

2. In case of a serious injury requiring medical or dental attention, the child’s parents/guardians will

be notified as soon as possible. If we are unable to contact a parent/guardian, your alternative

contact person (Three Persons Authorized to Pick Up Your Child from Preschool) will be called.

If it has been deemed that emergency transport is necessary, the preschool will contact

emergency services. Your child will be transported by ambulance to the nearest hospital as

follows: Abbotsford Regional Hospital / 32900 Marshall Road / Abbotsford, B.C. / PH: 604-851-

4700. A staff member will accompany your cild to the nearest emergency facility. Any expenses

incurred in this situation will be the parent/guardian’s responsibility.

I have read the above, and understand that in the event of an emergency, MEI Preschool will choose

the best possible alternatives. I show my agreement with the above possible plans by signing below.

Your Name: ______________________________ Relationship to Child: ______________________

Your Signature: ____________________________ Date: ___________________________________

P h o n e : ( 6 0 4 ) 8 5 9 - 3 7 0 0

F a x : ( 6 0 4 ) 8 5 9 - 7 5 9 9

h t t p : / / w w w . m e i s c h o o l s . c o m

( l o o k f o r t h e p r e s c h o o l l i n k )

Preschool Registration Form Page 4