Emergency Contact Information
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Text in this Example:
Emergency Contact and Medical Information for a Child
Date of Birth
City, ST ZIP Code
Alternate Emergency Contacts
Primary Emergency Contact
Secondary Emergency Contact
Allergies/Special Health Conditions
I authorize all medical and surgical treatment, x-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver only applies in the event that neither parent/guardian can be reached in the case of an emergency.
I give permission for my child to go on field trips. I release [Organization] and individuals from liability in case of an accident during activities related to [Organization], as long as normal safety procedures have been taken.