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Alabama Other: _________________________ Rules and Habits Special Conditions: After Hours Number: Schedule & Instructions Meals: __________________________ Snacks: _________________________ Naps: __________________________ Bedtime: _______________________ : Medical/Health/Insurance Care Information Child's Doctor Name: Address: Office Telephone: Health Insurance Company: Group or Policy Number: Telephone Number: Medications: Allergies: Immunizations: d's Age: Parent(s) and Other Contacts Mother's Name: Father's Name: Address of Parent(s): Home# Second Contact Name: Relationship: Third Contact Name: Relationship: Work# Phone Number: Phone Number_______ (state). ________________________________ Signature of Parent ________________________________ Signature of Parent Child Care Information and Instructions Child's Name: Child's Nickname: Chiln the Activity. This Consent Form may be revoked at any time before the expiration date with written notice to Organizer. Signed on ________________ (date), at _______________________ (city), ________of action (collectively the "Claims") in respect of death, injury, loss or damage to the Child or by the Child, howsoever caused, arising or to arise by reason of or during the Child's participation i defend and forever discharge the Organizer and its staff, employees and agents (collectively the "Organizer") of and from all liability, claims, demands, damages, costs, expenses, actions and causes withdraw life-sustaining procedures for the Child. The undersigned assume(s) all risk of injury or harm to the Child associated with participation in the Activity and agree(s) to releases, indemnify,contact the parent(s) and/or guardian(s) before administering or authorizing any treatment. Notwithstanding other provisions in this Consent Form, Organizer shall not have the authority to withhold orto the administration of anesthesia, X-ray examination, performance of operations, diagnostic and other procedures. If there is no medical emergency, the guardian will first use reasonable efforts to ecute any consent form required by medical, dental or other health authorities incident to the provision of medical, surgical or dental care to the child. Health care shall include but not be limited other institution; employ any physicians, dentists, nurses, or other person whose services may be needed for such health care; review and if necessary disclose the contents of any medical records; exreby further authorize(s) any of the staff, employees, agents and representatives of Organizer to provide for, approve and authorize any health care at any hospital, emergency room, doctor's office or______________________________________ (Name of "Organizer") and to the participation of the Child in all events relating to the activity on _______________ through _______________. The undersigned heand/or guardian(s) of the above child (the "Child"), hereby consents to the participation by the Child in ____________________________________________________ (describe activity) conducted by _______________________ born on __________ Social Security Number: ____________________________________ Address: ________________________________________________ The undersigned(s) being the lawful parent(s) bstitute for legal advice. Furthermore, this information is general information that is not state specific. PARENTAL PERMISSION AND MEDICAL CONSENT WITH LIABILITY RELEASE RE: Name: __________________l Consent has a beginning and an "end/expiration" date, the Parent(s) can revoke the document at any time even before the end date. Please note that this information is not intended as and is not a sulity Release Form also releases the organizer of the activity from any liability, holds them harmless and indemnifies them in the event of injury or damage. Although the Parental Permission And Medicatain emergency medical procedures. Medical personnel will also generally feel more comfortable dealing with someone who can provide this type of document. The Permission and Medical Consent with Liabir medical, dental or any other type of care. This can be especially important on a school or scouting trip if a medical emergency arises when the parents may not be readily available to consent to cerpe of document available, the organizers of the activity will be able to better deal with any types of emergency involving the children and can avoid potential problems when, for example, arranging forticipate in a specified activity as defined in the form. This form also grants the organizers of the activity the power to make health care related decisions on behalf of the child. By having this tyam etc...) and to (b) release the organizer of the activity from liability. A "Parental Permission And Medical Consent with Liability Release" Form allows parents to give consent for their child to palease It sometimes is necessary for parents to (a) give their permission so that their child can participate in some form of organized activity (i.e. a school trip, excursion, scouting trip, sports tetorney first. [_] The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com Information Parental Permission And Medical Consent with Liability Re for their records. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an atnizers of the activity the child will be participating in. [_] The Parents should keep copies of the Parental Permission And Medical Consent with Liability Release and Child Care Instructions document Permission And Medical Consent with Liability Release. [_] The original Parental Permission And Medical Consent with Liability Release and Child Care Instructions document should be given to the orgastructions (3) simple instructions plus a checklist; and (4) additional useful information about Parental Permission And Medical Consent documents. [_] Either one or both Parents can sign the ParentalInstructions & Checklist Parental Permission And Medical Consent with Liability Release [_]This package contains a (1) Parental Permission And Medical Consent with Liability Release; (2) Child Care In Alabama