Child Emergency Contact Form

P.O. Box 305
Carpinteria, CA 93014
Tel.: (805) 448-1186

I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be preformed or prescribed by the attending physician and or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in case of emergency.

I give permission for my child to go on field trips. I release 24/7 Nanny and individuals from liability in case of accident during activities related to 24/7 Nanny, as long as normal safety procedures have been taken.

Leave this empty:

Signature Certificate
Document name: Child Emergency Contact Form
Unique Document ID: 6fd7c9a2cb89d6241c78578ce84dd42ca7390ee2
Timestamp Audit
April 12, 2018 12:10 pm PDTChild Emergency Contact Form Uploaded by Rachel Oatis - IP
October 10, 2018 11:19 am PDT Document owner has handed over this document to 2018-10-10 11:19:43 -