Abilities Emergency Forms
  • Please update forms if any changes arise. 
  • Please provide the school with your child's most current clearance to attend school and immunization record.
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Email *
I am enrolling my child in the following class *
Student's Last Name *
Student's First Name *
Name of primary person to contact in case of medical emergency. *
Phone number to contact in case of emergency. *
Name of child's physician *
Phone number of child's physician *
Please note any allergies or medical conditions your child may have.
*Please provide your child's teacher with written information on symptoms/signs, triggers, and a medical plan should any medical episode occur while at Abilities. 
In addition to the child's parents/legal guardians, the following people (please note relationship to child) have permission to pick my child up from Abilities. Please inform the school if there are any specific individuals who your child may not be released to. Please inform the teacher of changes in pick up routines/people.  *
By "signing" below I grant permission for Abilities personnel to secure proper treatment for my child in the event of an emergency.
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