Emergency Medical Release Sample Clauses

Emergency Medical Release. Must be filled out COMPLETELY with no NA or Same as Above. No scratch out, cross offs or white out allowed on this form.
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Emergency Medical Release. This is to certify that I voluntarily furnished medical and insurance information on the above designated child to Home Away From Home. I hereby request that in the event that I, or the people I designate for an emergency, cannot be reached in a timely manner, that an official representative of Home Away From Home will seek first aid or emergency medical care for my child including transporting them to the nearest emergency facility available. I further give my consent to any emergency facility and physician to administer necessary medical treatment to my child if I am unable to be reached or the situation necessitates immediate treatment. I also understand that any medical expenses of the above designated child are the sole responsibility of the parents/guardian. Physician Insurance Company __ Physician’s Phone Group/Policy No DISCIPLINE POLICY: Conscious Discipline: At HAFH it is our belief that the goal of discipline is to help the young child identify their feelings and gain inner self-control so they become aware of what is acceptable behavior. Developmentally appropriate guidance and classroom management promotes positive social skills, fosters mutual respect, strengthens self- esteem and supports a safe environment. Corporal punishment is NEVER permitted at HAFH. If a child displays an unprovoked act of aggression, kicking, punching, hitting, etc. toward another child or staff member we will immediately contact a parent and you may be asked to remove your child from the premises, and/or disenrollment may be necessary.
Sample 1Sample 2
Emergency Medical Release. This is to certify that I voluntarily furnished medical and insurance information on the above designated child to Tiny Turtles Preschool of Jupiter. I hereby request that in the event that I, or the people I designate for an emergency, cannot be reached in a timely manner, that an official representative of Tiny Turtles Preschool of Jupiter will seek first aid or emergency medical care for my child including transporting them to the nearest emergency facility available. I further give my consent to any emergency facility and physician to administer necessary medical treatment to my child if I am unable to be reached or the situation necessitates immediate treatment. I also understand that any medical expenses of the above designated child are the sole responsibility of the parents/guardian. Physician Insurance Company __ Physician’s Phone Group/Policy No DISCIPLINE POLICY: Conscious Discipline: At Tiny Turtles Preschool of Jupiter it is our belief that the goal of discipline is to help the young child identify their feelings and gain inner self-control so they become aware of what is acceptable behavior. Developmentally appropriate guidance and classroom management promotes positive social skills, fosters mutual respect, strengthens self-esteem and supports a safe environment. Corporal punishment is NEVER permitted at Tiny Turtles Preschool of Jupiter. If a child displays an unprovoked act of aggression, kicking, punching, hitting, etc. toward another child or staff member, we will immediately contact a parent and you may be asked to remove your child from the premises, and/or disenrollment/terminate enrollment may be necessary.
Sample 1
Emergency Medical Release. Permission is granted for emergency medical treatment if necessary…… SIGNATURE OF PARENT/GUARDIAN: DATE: PLEASE PRINT PARENT/GUARDIAN NAME: _DATE: PICK-UP AUTHORIZATION Listed below are people authorized to drop-off and pick-up your child. Your child will not be released to anyone unless they are listed below. PLEASE LIST YOURSELF, relatives, guardians, friends etc. In an effort to ensure the safety of your child, you or whoever is picking up the child may be asked to show a picture I.D. Please make sure to inform the individual picking up your child of this policy to avoid any confusion or frustration at the time of pick-up. Thank you for your cooperation. NAME: _ RELATIONSHIP: PHONE: _CELL: _ NAME: _ RELATIONSHIP: PHONE: _CELL: _ NAME: _ RELATIONSHIP: PHONE: _CELL: _ NAME: _ RELATIONSHIP: PHONE: _CELL: _ NAME: _ RELATIONSHIP: PHONE: _CELL: _ PLEASE NOTE: Pick-up Authorization only applies to programming with pre-registration. If your child is participating in a drop-in program, such as the roller skating program or open gym activities, it is your responsibility to ensure your child is safely dropped off and picked up from these programs. Eureka Recreation staff will not be responsible for your child’s whereabouts once they have left the drop-in program and they will not verify the identity of any individuals picking up the child.
Sample 1
Emergency Medical Release. This is to certify that I voluntarily furnished medical and insurance information on the above designated child to Prosperity Day School. I hereby request that in the event that I, or the people I designate for an emergency, cannot be reached in a timely manner, that an official representative of Prosperity Day School will seek first aid or emergency medical care for my child including transporting them to the nearest emergency facility available. I further give my consent to any emergency facility and physician to administer necessary medical treatment to my child if I am unable to be reached or the situation necessitates immediate treatment. I also understand that any medical expenses of the above designated child are the sole responsibility of the parents/guardian. Physician _____________________________ Insurance Company________________________ Physician’s Phone ________________________ Group/Policy No________________________ DISCIPLINE POLICY: Conscious Discipline: At Prosperity Day School it is our belief that the goal of discipline is to help the young child identify their feelings and gain inner self-control so they become aware of what is acceptable behavior. Developmentally appropriate guidance and classroom management promotes positive social skills, fosters mutual respect, strengthens self-esteem and supports a safe environment. Corporal punishment is NEVER permitted at Prosperity Day School. If a child displays an unprovoked act of aggression, kicking, punching, hitting, etc. toward another child or staff member, we will immediately contact a parent and you may be asked to remove your child from the premises, and/or disenrollment/terminate enrollment may be necessary.
Sample 1
Emergency Medical Release. This is to certify that I voluntarily furnished medical and insurance information on the above designated child to Home Away From Home. I hereby request that in the event that I, or the people I designate for an emergency, cannot be reached in a timely manner, that an official representative of Home Away From Home will seek first aid or emergency medical care for my child including transporting them to the nearest emergency facility available. I further give my consent to any emergency facility and physician to administer necessary medical treatment to my child if I am unable to be reached or the situation necessitates immediate treatment. I also understand that any medical expenses of the above designated child are the sole responsibility of the parents/guardian. Physician Insurance Company __ Physician’s Phone Group/Policy No PHOTO RELEASE: I _ do/ do not give permission for my child to be photographed at HAFH. I understand these pictures may be displayed at certain school wide events, decorations, advertising/website and promotional reasons.
Sample 1
Emergency Medical Release. Return Completed Form To: 181471 Ontario Inc. (“Producer”) 00 Xxxxxxxx Xx., Suite 400 Toronto, Ontario M6J 2R9 IN CASE OF EMERGENCY, I, by signing below, authorize Producer, Endemol Argentina S.A.., each of their respective parent, subsidiary and affiliate companies, and each of their respective agents, employees, representatives, and contractors, to arrange for and/or provide such medical assistance to me as any of them determines to be necessary. I also authorize any physician, other medical/paramedical provider, and/or medical facility to provide any medical/surgical care and/or hospitalization to me, including anesthetics, which any of them determine to be necessary or advisable, pending receipt of a specific consent from me. DATE: SIGNED: Print Name: Emergency Contact Name: Relationship: Their address: City: Province: Postal Code:
Sample 1
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Related to Emergency Medical Release

  • Medical Release I release and forever discharge the Released Parties from any claim whatsoever arising, or that may arise, on account of any first aid, treatment, or medical service, including the lack of such or timing of such, rendered in connect with my participation as a volunteer.

  • Emergency Medical Care a. How to appropriately use Emergency Services and facilities, including a description of the services offered by the Member Services Call Center;

  • Emergency Medical Condition A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the following: (1) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (2) serious impairment to body functions; or (3) serious dysfunction of any body organ or part.

  • Medical Records Retention Grantee will;

  • Emergency Medical Services The City’s Fire Department and MedStar (or other entity engaged by the City after the Effective Date) will provide emergency medical services.

  • MEDICAL REPORT The Agency/Department Head as a condition of granting sick leave with pay, may require medical evidence of sickness or injury acceptable to the Agency/Department. The acceptable medical evidence must be obtained from a medical practitioner currently treating the employee or the employee’s family member.

  • Medical Care and Emergency Leave An employee is entitled to a leave of absence without pay because of any of the following:

  • Medical Records Medical records relating to Trial Subjects that are not submitted to Sponsor may include some of the same information as is included in Trial Data; however, Sponsor makes no claim of ownership to those documents or the information they contain. c.

  • Dental Services - Accidental Injury (Emergency Emergency room - When services are due to accidental injury to sound natural teeth. 0% - After deductible The level of coverage is the same as network provider. In a physician’s/dentist’s office - When services are due to accidental injury to sound natural teeth. 0% - After deductible 40% - After deductible Dental Services - Outpatient Services connected to dental care when performed in an outpatient facility * 0% - After deductible 40% - After deductible Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Dental Care (Pediatric) - for members under age 19 See Dental Services in Section 3 for benefit limits and details. These services only apply to an enrolled member under the age of 19. Oral evaluations 0% - After deductible 0% - After deductible X-rays 0% - After deductible 0% - After deductible Cleanings (prophylaxis) 0% - After deductible 0% - After deductible Fluoride treatments 0% - After deductible 0% - After deductible Sealants 0% - After deductible 0% - After deductible Space Maintainers 0% - After deductible 0% - After deductible Palliative treatment 50% - After deductible 50% - After deductible Fillings 50% - After deductible 50% - After deductible Simple extractions 50% - After deductible 50% - After deductible Denture repairs and relines/rebasing 50% - After deductible 50% - After deductible Crowns & onlays 50% - After deductible 50% - After deductible Therapeutic Pulpotomies 50% - After deductible 50% - After deductible Root canal therapy 50% - After deductible 50% - After deductible Non-surgical periodontal services 50% - After deductible 50% - After deductible Surgical periodontal services 50% - After deductible 50% - After deductible Periodontal maintenance 50% - After deductible 50% - After deductible Fixed bridges and dentures 50% - After deductible 50% - After deductible Implants 50% - After deductible 50% - After deductible Oral surgery services 50% - After deductible 50% - After deductible General anesthesia or IV sedation - dental office 50% - After deductible 50% - After deductible Biopsies 50% - After deductible 50% - After deductible Occlusal (night) guards 50% - After deductible 50% - After deductible Orthodontic services (braces) - when medically necessary. 50% - After deductible 50% - After deductible Dialysis Services Inpatient/outpatient/in your home 0% - After deductible 40% - After deductible Durable Medical Equipment (DME), Medical Supplies, Diabetic Supplies, Prosthetic Devices, and Enteral Formula or Food, Hair Prosthetics Outpatient durable medical equipment* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient medical supplies* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Outpatient diabetic supplies/equipment purchased at licensed medical supply provider (other than a pharmacy). See the Summary of Pharmacy Benefits for supplies purchased at a pharmacy. 20% - After deductible 40% - After deductible Outpatient prosthesis* - Must be provided by a licensed medical supply provider. 20% - After deductible 40% - After deductible Enteral formula delivered through a feeding tube. Must be sole source of nutrition. 20% - After deductible 40% - After deductible Enteral formula or food taken orally * 20% - After deductible The level of coverage is the same as network provider. Hair prosthesis (wigs) - The benefit limit is $350 per hair prosthesis (wig) when worn for hair loss suffered as a result of cancer treatment. 20% - After deductible The level of coverage is the same as network provider.

  • Emergency Medical Treatment I grant the Releasees permission to authorize emergency medical treatment as they deem appropriate, and agree that such action by the Releasees shall be subject to the terms of this Agreement. I understand and agree that the Releasees assume no responsibility for any injury or damage that might result from such emergency medical treatment.

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