Personal Information Form 2016-17

EMERGENCY TRANSPORT CONSENT I understand that no emergency treatment will be given without parental consent except in a life-threatening situation. Since informed consent must be given at the time of the incident, please provide numbers where parents, guardians, or a responsible adult may be reached daily. In case of a medical emergency while your student is on the campus at The First Presbyterian Church of Ft. Lauderdale, the following procedure will be followed:

 

MEDICAL RELEASE I grant permission for my child participate in all activities on the campus of First Presbyterian Church of Ft. Lauderdale. I give First Pres authorization to seek emergency medical treatment for my student. First Pres will arrange emergency transportation to the nearest medical facility if necessary. Due to safety regulations, injured or ill children must be transported to a hospital by paramedics or ambulance. They cannot be transported by staff or friends. I give any health facility or physician permission to provide medical treatment for my child as necessary in an emergency situation that may arise while on campus at First Pres. I also authorize Frist Pres to have my student released into the custody of its representative, should hospital care no longer be required. This release is to be used only in case of emergencies. I will take full responsibility for payment of all medical services, including transportation, tests, and any fees involved with medical care received, which might be rendered due to any emergency situation that may arise at First Presbyterian Church of Ft. Lauderdale.

 

Signature of Parent/Legal Guardian *
(use your mouse to sign your name in the box below) [signature* parent-signature]

 

[radio* parents-status default:1 "Married" "Separated" "Not Married" "Divorced" "Other"]Parents are:[/radio*]