The Preschool of West Hartford, Inc. Emergency Help Form

Sana27.06.2017
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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



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