Consent for Emergency Treatment We give permission for our child(ren) ____________________ to receive emergency treatment (first aid, C.P.R.) by The Learning Playhouse We also give our permission for the above child(ren) to be transported by ambulance, car, or any way Mrs. Laurie feels is necessary to an emergency center for treatment. We agree to pay any costs that may occur. In the event that we cannot be contacted, we further consent to the medical, surgical and hospital care treatment and procedures to be performed for the above child(ren) by a licensed physician or hospital when deemed immediately necessary or advisable by the physician to safeguard our child(ren)’s health. We give consent for The Learning Playhouse to administer over the counter type medication (Tylenol, Dimetapp, Diaper cream, Sun Block etc…) to the above child(ren). We give consent for The Learning Playhouse to administer prescription medication to the above child(ren) this being in the original container with the child’s name, date prescribed and dosage on the label. Father’s name and signature ___________________________ Mother’s name and signature ___________________________ Date ____________ Please include a copy of each child’s immunization record for their file.