Consent for Emergency Treatment of a Child

When your child is injured or becomes ill and you can’t be there, we’ll provide the necessary medical attention. This form enables healthcare professionals to treat your child for minor emergencies when, and only when, you cannot be notified.

By filling out the form, you'll be able to provide not only your permission for medical treatment, but also important health information needed for the care of your child. You may want to keep one copy for yourself and give another copy to the person who will be responsible for your child when you cannot be present. Be sure to specify that person’s name on the form.

Consent Form