2021 Medical Treatment Form

2021 PERMISSION FOR MEDICAL TREATMENT
BY PARENT/LEGAL GUARDIAN OF MINOR CHILD
FOR ROCK HOLLOW WOODS ENVIRONMENTAL LEARNING CENTER

I grant Rock Hollow Woods Environmental Learning Center, its employees, agents, interns, volunteers, directors or officers (collectively, “Rock Hollow Woods”) permission to administer basic first aid when applicable, including the treatment of minor cuts, scrapes, burns (including sunburns) and stings. Medication will not be administered by Rock Hollow Woods at any time. I hereby give permission to medical personnel and Emergency Medical Services selected or contacted by Rock Hollow Woods to provide transportation and treatments for my child. In the event that I cannot be reached in an emergency, I hereby give permission to the physician and hospital where I am transported to secure and administer treatment, including hospitalization and surgery, for my child. I agree to assume financial responsibility for all medical and hospital expenses.

I Agree to the Terms *

I Agree

* Indicates required field

Name of Minor Child *

First

Last

Name of Parent/Guardian *

First

Last

Relationship to Minor Child *

Submit

HB/Permission for medical treatment Rock Hollow Woods 050313

2021 PERMISSION FOR MEDICAL TREATMENT​BY PARENT/LEGAL GUARDIAN OF MINOR CHILDFOR ​ROCK HOLLOW WOODS ENVIRONMENTAL LEARNING CENTER

2021 PERMISSION FOR MEDICAL TREATMENT
BY PARENT/LEGAL GUARDIAN OF MINOR CHILD
FOR ROCK HOLLOW WOODS ENVIRONMENTAL LEARNING CENTER