The Preschool of West Hartford, Inc. Emergency Help Form

The Preschool of West Hartford, Inc.

Emergency Help Form

The Preschool of West Hartford will make every effort to contact parents in the event of a medical emergency for your child.

In the event The Preschool of West Hartford is unable to contact me, I hereby give the staff at The Preschool of West Hartford permission to seek emergency medical help for my child _____________________________________________________________.
The hospital of choice for my child is _________________________________________
____________________________________________________________.


My child’s medical insurance coverage information:
________________________________________________________________________

Insurance company name

________________________________________________________________________

Policy number

________________________________________________________________________

Parent Signature
________________________________________________________________________

Date

860-561-3241 1 Westminster Drive, West Hartford, CT 06107

www.thepreschoolofwesthartford.com