I/We, the undersigned, have legal custody of the student named above, a minor, and have given consent to the Weitzman Family Religious School supervision during the 2018 – 2019 school year.
In case of medical emergency, I/we understand that every effort will be made to contact the parent or guardian. In the event that I/we cannot be reached, I/we hereby authorize and consent to my child to be transported to the nearest medical facility in addition to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general or specific supervision of any licensed medical personnel on the staff of a licensed hospital. This authorization is given in advance of any specific diagnosis, treatment or hospital care required, but is given to provide authority and power to render care which is deemed advisable in the best judgment of the physician. I/we am responsible for payment of all fees incurred.