AUTHORIZATION FOR PEDIATRIC - EMERGENCY - MEDICAL AND/OR SURGICAL TREATMENT
THE JEWISH EXPERIENCE AT CENTRAL SYNAGOGUE - BETH EMETH 2018 – 2019 / 5779
It is our firm hope that the authorization on this form will never need to be used. For the safety of the children, however, sound medical practice calls for such authorization. In emergency situations, where for some reason the parent of the child cannot be contacted immediately, this form is extremely important. The authorization granted by this form will be used only when absolutely necessary and only after every attempt has been made first to contact the parent. Please indicate below two (2) emergency numbers at which we may be able to reach a parent or obtain information as to their whereabouts. We find that doctors and hospitals refuse to give any treatment regardless of how minor, unless they have authorization from a parent. As you know, time can be a factor in being of assistance to your child if medical attention is needed. Your signature on this form help us be sure that no time is lost in getting immediate treatment for your child if it becomes necessary. Thank you.

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