Student's full name First Name* Last Name* Parent's names First Name* Last Name* First Name Last Name Address Street Address* City* State* Zip* Home phone Phone Number* Emergency Phone Phone Number* List all of the student's allergies or health problems below. If there are none, please indicate: Explain Here* Parent's Statement: In the event, my child becomes ill or is injured while under the supervision of Veritas Classical Schools, I approve the school authorities taking the following steps in the following order.
If in the opinion of a properly licensed and practicing physician my child needs medical or surgical services, which require my consent being supplied, and I cannot be reached, I hereby authorize, appoint, and empower Veritas Classical School authorities to furnish on my behalf such written or oral consent as may be required. Furthermore, I release Veritas Classical Schools and its authorities and representatives from any liability, which might arise from the giving of such authorization, it being my desire that my child is furnished with such medical or surgical services as soon as possible after the need arise. Parent signature: Signature*First Name*Last Name* Date