Temple Adath B'Nai Israel Medical Release Form

In case of injury or illness of a child at school, every effort will be made to contact the parent or guardian. The following instructions will remain in force unless revoked by parent or guardian:

In case you cannot be reached, who is the emergency contact?

In the event of a medical emergency, I authorize the staff to obtain emergency medical treatment for my child. I understand that I will be contacted immediately as will my physician.