MEDICAL/EMERGENCY CONTACT

MEDICAL/EMERGENCY CONTACT
This card authorizes
Name of volunteer (Big)
to secure proper medical treatment or surgical procedure for my child by a qualified staff physician at a recognized hospital in the case of an emergency illness or accident when I am not immediately available to respond
Name of child
Parent Guardian Signature

Clear
Parent Name
Emergency Contact #1 Name
Emergency Contact #1 Phone
Emergency Contact #2 Name
Emergency Contact #2 Phone
Emergency Contact #3 Name
Emergency Contact #3 Phone
Childs allergies to medication and/or medical conditions
Childs Medications taken on a regular basis
Medical Insurance
Policy Number
Doctors Name
Doctor's Phone Number
Should be Empty: