ATLANTA FINNISH LANGUAGE SCHOOL
PERMISSION TO TREAT
and WAIVER OF LIABILITY

 

The parents of __________________________________________ give permission for any adult affiliated with the Atlanta Finnish Language School to get any medical attention necessary in the event of emergency for above minor(s) should the parents be unavailable/unreachable.
The child may be transported to any medical facility that the emergency medical response professionals deem appropriate or to the closest Emergency Room or Children’s Healthcare of Atlanta facility.

The parents of __________________________________________________hold Atlanta Finnish Language School harmless for any injuries or accidents that occur during Atlanta Finnish Language School activities. Additionally, parents agree to hold harmless Atlanta Finnish Language School and their respective officers, directors, employees, and agents. Parents understand that the children participate in school activities at their own risk. Parents are also responsible for the damages caused by their children for the materials or facilities used by Atlanta Finnish Language School.

__________________________________ ________________________________
Name of Parent(s) Signature(s) of Parent(s)
Date: ____________________________________________
Insurance Company/Policy Name____________________________________________
Insurance Policy #______________________________ Group #___________________
Insurance company customer service phone numbers_____________________________
Parent’s cell phone numbers: ____________________________________________________
In case parents are unreachable please call:
__________________________________________________________
Contact name & phone numbers