Emergency File

 
Doctors Name   
Doctors Address
Allergies (if any, please list)
Medical Conditions
If any please explain


 

Emergency Contact Information

 
Emergency Contact 1
Phone
Emergency Contact 2
Phone


PERMISSION FOR EMERGENCY MEDICAL TREATMENT

As the parent(s) or legal guardian of , I/we authorize any adult acting on behalf of Chabad Hebrew School of Lake Grove to hospitalize or secure treatment for my child.  I further agree to pay all charges for that care and/ or treatment.  It is understood that if time and circumstances reasonably permit, Chabad Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment.      

 

I hereby give permission for my child to attend all field trips and outings sponsored by Chabad Hebrew School.

Signature of Parent or Legal Guardian