Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Ola Academy Early Learning & Child Care 2773 Highway 81 East, McDonough, Georgia 30252 Emergency Medical Authorization Should ________________________________, _____________________ suffer an injury [Child’s name] [Date of Birth] or illness while in the care of Ola Academy and the facility is unable to contact me (us) immediately, it shall be authorized to secure such medical attention and care for the child as may be necessary. I (We) agree to keep the facility informed of changes in telephone numbers, etc. where I can be reached. Ola Academy agrees to keep me informed of any incidents requiring professional medical attention involving my child. Child’s primary source of health care is: ____________________________________ Telephone Number: ________________________________ [Physician/Clinic Name] _______________________________________________________________________ [Address] Known medical conditions (i.e. diabetic, asthmatic, drug allergies): ___________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________ Does your child have any other type of allergies we should be aware of? (i.e. any type of food such as milk or peanuts, synthetic materials, etc.) ___________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________ _________________________________ Signature (Parent/Guardian) Telephone Number ___________________ _____________ Date