Rockland Montessori Academy For Young Learners

AUTHORIZATION AND CONSENT FORM

I understand that every effort will be made to contact me in the event of an emergency

requiring medical attention for my child_____________________________________(name)

However, if I cannot be reached, I hereby authorize the Rockland Montessori Academy to

transport my child to the ________________________________ Hospital (or nearest hospital)

and to secure for my child the necessary medical treatment. I understand the staff members

in the preschool are trained in the basics of First Aid and I authorize them to give

my child First Aid when appropriate.

Parent/Guardian Signature_________________________________________________Date____________________

EMERGENCY RELEASE FORM

I give my permission for my child to be released from the program and/or to be received at the end of the program to the following people (list at least two adults who are NOT parents):

Name________________________________ Relationship to child__________________________

Address______________________________ Phone number________________________________

Name________________________________ Relationship to child__________________________

Address______________________________ Phone number________________________________

Name________________________________ Relationship to child__________________________

Address______________________________ Phone number________________________________

Parent/Guardian Signature_________________________________________________Date____________________