I First Name * Last Name * , the parent or guardian of First Name * Last Name * , born on Date * do hereby consent to the transportation of my child to hospital preference * or the nearest hospital in the case of an emergency situation.I First Name * Last Name * parent of First Name * Last Name * , also agree to any medical care determined by a physician to be necessary for the welfare of my child while said child is the care of School Name * City of city name * , State of State Name * and I am not reasonably available by telephone to give consent. This authorization is effective from Date * to Date * . I also acknowledge that any and all transportation and medical care of child First Name * Last Name * , will be the responsibility of the parent and or guardian. Signature * Date * First Name * Last Name * (Please Type Full Name of person signing form)