Medical Consent Form

Medical Information and Release Form

Please complete one form per child enrolled in Chabad ELC.

CHILD INFORMATION

Child's Full Name *

First

Last

Date / Time *

Gender *

MEDICAL INFORMATION

Doctor's Name *

Doctor's Phone *

Please indicate any allergies or medical conditions and protocols the school should be aware of:

RELEASES

Trips

By clicking this tab, I hereby give my child permission to go on walking trips in the neighborhood and on trips via school bus or public transportation. I understand that I will receive notification of upcoming trips through the school calendar and email. I further understand that the children may go on walking trips in the neighborhood without prior notification.

Emergency Policy

By clicking this tab, I hereby acknowledge that I have read and understood that in case of medical emergency, G‑d forbid, the school will call Hatzalah or 911. If the Emergency Responders decide that the situation warrants swift medical attention, child will be taken to nearest hospital together with his/her medical file. Parents will be immediately notified. Until a parent is reached, the director or teacher will be in charge and make all decisions about the care of the child. In all non-emergency situations, the parents will be contacted. If parents cannot be reached, we will contact your pediatrician and follow instructions. In situations where the child must be taken home and you cannot be reached, we will contact the people indicated above. By signing this form you also consent to assume any and all fiscal responsibilities incurred by the school in the course of your child's medical emergency. I hereby authorize the Chabad Early Learning Center to obtain necessary medical treatment for my child in accordance with the above-mentioned Emergency Policy.

Sunscreen, Antiseptic and Diaper Cream

By clicking this tab, I hereby give permission to the staff of Chabad Early Learning Center to apply topical, over-the-counter creams to my child according to label instructions.

Media Release

By clicking this tab, I hereby give Chabad Early Learning Center permission to use my child’s likeness for publicity purposes on social media (i.e. Facebook, Instagram, Chabad ELC website etc.), to help promote their program.

Observations & Screenings

From time to time educational professionals retained by Chabad Early Learning Center, such as a school psychologist, occupational therapist etc., will be observing my child's classroom. I hearby give permission for my child to be present during such observations.

COVID-19 - Information Release

In the event that my child or any other household member test positive for COVID-19, I will immediately inform the school. In addition, if any child or household member enters quarantine, I will inform the school as well.