Please list all allergies, including food, environmental and pharmaceutical. List any medical conditions or limitations. if none, please list "none".
Note: Since T-shirts must be ordered well in advance, we cannot guarantee your preferred size but if necessary will substitute the best fit from available sizes.
Authorization for Medical and/or Surgical Treatment and for Release of Information
Every effort is made to contact and inform the parents or guardians in case of a medical emergency, serious injury, or illness when immediate medical or surgical intervention is deemed necessary. On isolated occasions the parents or guardian cannot be reached. Accordingly, they are requested to sign the following statement:
In the event of illness or accident involving our/my son/daughter, we/I hereby give permission to The Phoenix School, its officials, and the treating physicians, surgeons, and dentists, to secure and furnish medical, dental, or surgical care and treatment for him/her and to give, administer, and render any treatment or aid, including anesthetics or surgery, as is necessary to protect, preserve, and safeguard the life and health of our/my son/daughter.
We/I further authorize The Phoenix School to release information to facilitate the medical or surgical care of our/my son/daughter, as is necessary for the completion of a claim for health insurance.
I give permission to the Vacation Adventures instructor to share information relevant to my child’s health condition with appropriate school personnel when needed to meet my/our child’s health and safety need.
