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Emergency Care Information

Please complete the form below. Required fields marked with an asterisk *

EMERGENCY CARE INFORMATION

In case of an emergency, the school will contact 911. Every attempt will be made to contact a parent, or a designated emergency contact.

Student Information

Parent/Guardian Information

Student resides with (check one)*
Answer Required

Parent 1:

Parent 1 Home Address:

Parent 2:

Parent 2 Home Address:

Same address as parent 1*
Answer Required

If No, please answer the following questions:

If you are unable to reach me during any emergency, you are authorized to contact, and if necessary, release my child to any of the following:

Medications

I give my child permission to take*
Check all that apply
Answer Required
I give my child permission to take over the counter medication that is brought in by the parent with instructions*
Answer Required
My child may have first aid administered as deemed necessary*
Answer Required

Current Health Conditions

Below check any current health condition that may require attention during the school day:

Allergies (be specific) - list reaction and treatment

Does your student have:
Check all that apply
Answer Required
By clicking accept, I hereby authorize The Jewish Academy of Orlando located at 851 N. Maitland Avenue, Maitland, Florida, by and through its designated agents, employees, and/or volunteers, to administer medications and/or first aid to my child. In consideration for Jewish Academy of Orlando administering medicine and first aid to my child as referred to herein, I hereby agree to indemnify and hold harmless Jewish Academy of Orlando, it’s officers, directors, agents, employees, and volunteers, from any and all liability that may arise out of the administering of medicine and first aid to my child, the following of the written instructions that I have provided herewith, or the direct or indirect consequences of either. Although the above recommendation of the parent will be respected as much as possible, In understand that in the final disposition of any emergency case, the judgement of the school will prevail. Anytime the above information changes, I will notify in writing. In the event my child needs to be transported to the hospital for emergency treatment, I will be responsible for all incurring costs.*
Answer Required
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