Emergency Contact

Emergency Contact
In case of medical or other emergency requiring immediate attention during school hours, I authorize the school to contact according to the priority list below:
Name Relationship to student Phone
Emergency Medical Release Form
- In the event that I am unable to be reached during an emergency, I hereby authorize the Ohr HaTorah Yeshiva for Boys and/or its representative to secure any necessary and proper treatment, including hospitalization, injection, anesthesia or surgery, as has been deemed necessary for my son.
Student’s Name
Grade
Parent’s Name
Parent’s Signature
Date
Date Format: MM slash DD slash YYYY
Consent to Dispense Medication
Please check all that apply:
- In the event that I am unable to be reached, I hereby authorize the Ohr HaTorah Yeshiva for Boys and/or its representative to dispense, if needed, to my son over-the-counter non-prescription medications (such as Aspirin, Benadryl, Tylenol, Pepto Bismol).
My son is allergic to
- DO NOT DISPENSE. Other medications may be dispensed as necessary.
- I hereby authorize the Ohr HaTorah Yeshiva for Boys and/or its representative to dispense prescribed medications that my son needs to take during the school day. Any such medication that I send for him will be kept in the school office and dispensed as directed.
- I decline permission to dispense any non-prescription medications to my son.
Parent’s Signature
Date
Date Format: MM slash DD slash YYYY