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LM Band Emergency Medical Authorization
Purpose - To enable parents and guardians to authorize the provision of emergency treatment for children who become ill or injured while under LMBB authority, when parents or guardians cannot be reached.
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* Indicates required question
Email
*
Your email
Student Information
First Name
*
Your answer
Last Name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
M/F
*
M
F
Allergies (List known allergies or NKA if none)
*
Your answer
Does the student carry an Inhaler?
*
Yes
No
Does the student carry an EpiPen?
*
Yes
No
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