Emergency Medical Release Form
Authorization for Emergencty Medical Attention
Persons to contact in case of emergency if parnts are not available/Personas para contactar en caso de emergencia si los padres no responden.
I understand that this child will NOT be released from COTRK to anyone except the persons named above. Names can be added or deleted at nay time. This change must be given to the COTRK office staff or child's teacher IN WRITING.
Entiendo que este nino NO saldrá de COTRK con nadie excepto a las personas mencionadas arriba. Los nombres se pueden agregar o eliminar en un cualquier momento. Este cambio debe ser dado al personal de la oficina de COTRK o al maestro del nino POR ESCRITO.
Consent for Treatment
Parent consent is a legal requirement for treatment of a minor child. To authorize emergency treatment of your child in the event you are unable to be contacted, the following affidavit must be signed.
"I am parent/legal guardian, hereby authorize CHILDREN'S MINISTRY CHURCH ON THE ROCK KATY Staff Member to consent to medical treatment of my child, when I cannot be contacted. Such consent includes, without limitation, x-rays, injections, anesthetic, medical, dental or surgical examinations or treatment and or hospital care. No prior determination of life threatening emergency or danger of treatment needs to be made under this Authorization. This authorization remain effective until August 4, 2019.