If a non custodial parent is not included among those persons authorized by the custodial parent to pick up the child, please explain below and attach a copy of appropriate court order.
I have completed the medical emergency permission form which authorizes the center to seek emergency medical care for my child as deemed necessary by the Director or the Director’s designee.
I (we) attest that all of the information on this application is accurate and that I (we) have received the following information for my (our) home records:
