To: Eastside Medical Center Child's First Name Child's Last Name Should my child, name listed above, suffer an injury or illness while in the care of Meadowbrook Montessori School and the school is unable to contact me immediately, Meadowbrook Montessori School shall be authorized to secure medical attention and care for my child as may be necessary. I certify that I will be liable for all transportation, medical, and hospital expenses incurred in this regard. I (we) agree to keep the school informed in changes in telephone numbers, etc. where I (we) may be reached. Meadowbrook Montessori School agrees to keep me informed of any incidents requiring medical attention involving my child. My child’s primary source of healthcare* Physician's Phone* Known medical conditions (i.e.) diabetes, asthma, drug/food* Step 1. Check the box below* By checking this box and typing my name below, I am electronically signing my agreement. Step 2. Type in your name* First Name Last Name [multistep multistep-5 last_step send_email]
