Emergency Medical Authorization
In the event of illness or accident that requires immediate medical treatment at a time when a parent or guardian cannot be located, I give permission for Wickline United Methodist Church Day School personnel to provide such emergency treatment to the best of their knowledge and ability. Children will be taken to SSM Health St. Anthony Hospital-Midwest. I will not hold the church or medical personnel responsible.
Signed: Parent/Guardian
Date
THIS FORM SHOULD BE PRINTED, SIGNED, AND RETURNED TO THE DAY SCHOOL WITH THE IMMUNIZATION RECORD IN ORDER TO COMPLETE ENROLLMENT.