Emergency Treatment Release

Parent/Guardian:
I, the undersigned do authorize officials of the Monroe County Schools to contact directly the persons named on the student information from and do authorize the named physician(s) to render such treatment as deemed necessary in an emergency, for the health of the student listed. I also authorize the school staff to render treatment as deemed necessary related to accident or illness.

In the event the parent/guardian and the other persons named on the Student Information Form cannot be contacted, the school officials are hereby authorized to take whatever action is deemed necessary in their judgment for the health of the student.

By signing the consent, I release the Monroe County Schools from any liability related to the administration of medication or treatment so long as reasonable and customary care is provided and I will not hold the school distinct financially responsible for emergency care and/or transportation for the above student.

I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION AND AGREE TO ALL CONDITIONS LISTED ABOVE. (Please type your name in the box for your signature)