PERMISSON TO TREAT & TRASNPORT STUDENT
I do hereby state that I am the parent/guardian of the child named on this form. In order to expedite care of this child, I hereby give permission for the responding emergency team to
immediately initiate treatment and transport of this child to the preferred or appropriate medical facility, according to what they deem is indicated by the nature or extent of the injuries. I also request that I be notified of my child’s condition and admission as soon as possible. If I am unable to be reached, I request the admitting facility notify one of the emergency contacts listed above about my child’s condition and admission. I agree to be financially responsible for this child’s treatment and transport. I will notify YEP of any changes to this information in writing.