Allergy/Medical Alert Information | Penfield Village Nursery School & Kindergarten

Child's Name*

Date of Birth*

Program*

Teachers*

Classroom #*

Symptoms/Reactions*

Treatment*

PVNS Medical Permission & Liability Release

I have read, I understand and agree to Penfield Village Nursery School & Kindergarten's

Medical Emergency Policy
Medication Policy
Allergy/Medical Condition Policy

I understand the Penfield Village Nursery School & Kindergarten does not have medical personnel available at their location.

I understand and agree that the staff of Penfield Village Nursery School are granted permission to authorize emergency medical treatment for my child.

I, the parent/guardian, herby release and agree to hold harmless Penfield Village Nursery School & Kindergarten, it's agents, officers and employees of any and all liability or responsibility in the event of any injury or damage which might arise out of my child's existing medical condition, (including agencies), or out of/in connection with authorized medical treatment.

Parent/Guardian Signature*

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Date*