Emergency Medical and Transportation Authorization
For participant name, born date of birth, at program name, business name. Signed date by guardian name, parent or legal guardian.
- Who to call first. guardian name on guardian phone. If I cannot be reached: second contact on second phone.
- Emergency medical care. If the child is injured or becomes ill and I cannot be reached in time, I authorise business name's staff to obtain emergency medical, dental and surgical care for the child, including transport by ambulance, and I authorise the treating clinician to provide care they judge necessary. I am responsible for its cost.
- Everyday care. Staff may give first aid, and may give the following as written here: routine medication. Nothing else is given without speaking to me.
- What the clinician needs to know. Allergies: allergies. Current medication: current medication. Conditions: conditions. Last tetanus, if known: tetanus date. Insurance or health cover: insurance details.
- Transportation. I authorise the child to be transported by business name in the vehicles it uses for the programme — vehicle types — driven by staff or by a contracted carrier, to and from the activities and trips listed in the permission form, and to medical care in an emergency. Seat belts and, where the law requires them, child restraints are used at all times.
- Private vehicles. Whether staff may carry the child in a private vehicle is set here: private vehicle permission.
- Telling me afterwards. business name will tell me as soon as it can about any injury, illness or treatment, however minor, and will record it.
This authorization runs from start date to end date and I may withdraw it in writing at any time.
By signing I confirm that I am the child's parent or legal guardian, that the information here is accurate, and that I meant to sign it.
