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Emergency Contact Information
List all other adults who are authorized to bring and/or take the child from EDJ Child Enrichment Center
do hereby give my consent to the
Director of EDJ Child Enrichment Center or the duly representative for said child to receive medical or surgival aid as may be deemed necessary and expedient by a duly licensed or recognized physician or surgeon in case of an emergency when the parents cannot be reached in a reasonable length of time. Consent is also given for the Director or his duly appointed representative to transport said child for emergency medical treatment, if a parent or Mobile Emergency Medical Service vehicle cannot respond promptly.
Disease History (if Any)
Child's Developmental Needs