In the event of an emergency or non-emergency situation requiring medical treatment, I, the undersigned parent, hereby grant permission for any and all medical and/or dental treatment to be administered to my child named above, in the event of an accidental injury or illness, until such time as I can be contacted. This permission includes, but is not limited to, administration of first aid, use of an ambulance, and administration of anesthesia and/or surgery, under the recommendation of qualified medical personnel.

I acknowledge I am the parent (or guardian) of the named student and have read and agree to the aforementioned statement.