EMERGENCY RELEASE:
The undersigned, as parent/guardian of the child named above, hereby authorizes any of the above named agencies staff to render necessary medical care and treatment of the aforesaid child of any illness or injury, which the child may suffer at any time while in their custody. It is understood that, time permitting, specific permission of the parent/guardian will be secured in the event any major treatment is to be undertaken. Should an emergency arise, this authorization and consent will cover such an event. I/we understand that none of the agencies named provide INSURANCE coverage and I agree to assume responsibility for payment for all medical cost incurred.
STAFF CANNOT ISSUE ANY TYPE OF MEDICATION

For program information please contact Laury Rowland • Program Director, lrowland@lifelinesmobile.org  or (251)431-5100 Ext. 270.