PERMISSION FOR EMERGENCY MEDICAL CARE

In order to meet all legal requirements, I hereby authorize representatives of the AFTER CARE program of HOLY SPIRIT SCHOOL to give consent for any and all necessary emergency medical care for my child while said child attend the program sponsored by HOLY SPIRIT SCHOOL AFTER CARE PROGRAM.

PARENT/GUARDIAN SIGNATURE _____________________________________________________________

DATE __________________

NAMES OF CHILD/REN ATTENDING THE PROGRAM

__________________________________________

__________________________________________

__________________________________________

SPECIAL INSTRUCTIONS

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________