Medical Consent Form

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Medical Consent Form

Kingsland Community Preschool has my permission to obtain emergency medical treatment for my child when I cannot be reached or if a delay in reaching my child would be dangerous for him/her.

Child's Name:*

Parent/Guardian’s Name: *

Home Phone:*

Email Address:*

Cell Phone:*

Parent/Guardian’s Name: *

Home Phone:*

Email Address:*

Cell Phone:*

Alberta Health Care Number:*

Allergies:

Medical Conditions:

Does any medication need to be administered?*

No

Yes

If Yes, please explain:

Should any of the information above change, I will notify Kingsland Community Preschool immediately of any changes. I understand that I assume all financial responsibility for any treatment or injuries sustained by my child while he/she is in childcare.

Name of Parent or Guardian filling out this form:*

Date:*

This field should be left blank