Child care emergency form with medical consent to treat
A child care emergency form gives your staff permission to get a child emergency medical care when a parent cannot be reached. It holds insurance, doctor, allergy and condition details on one page. Add your center details and download.
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Each section below shows what will print. Use the switch to keep or remove a section, edit the policy wording, and add your own questions at the bottom.
Your own questions
OptionalWhat is a child care emergency form?
It is the form a parent signs so your staff can act fast in a medical emergency. It gives permission to call 911 and get treatment if the parent cannot be reached, and it puts the facts emergency staff ask for first in one place: allergies, conditions, medicines, insurance and the child's doctor.
What to include in a child care emergency form
- Child's name, date of birth and approximate weight (paramedics use it for doses)
- Both parents' cell phones
- Health insurance company and member number, with a copy of the card
- The child's doctor, dentist and preferred hospital
- Allergies, medical conditions and daily medicines
- A signed consent to emergency treatment
- Any treatment the family does not allow, and why
How to use it in an emergency
Call 911 first
Give first aid, call 911, then call the parent. Never wait for a parent to answer before calling for help.
Send the form with the child
Give a copy to the paramedics or take it to the hospital. Keep the original in the child's file.
Keep a copy on trips
Take every child's emergency form on field trips and in vehicles, along with the emergency contact list.
Update it every year
Ask families to review the form at least once a year and whenever insurance, phone numbers or health needs change.
This form covers medical consent. For the list of people to call and who may pick up, use our emergency contact form for daycare. For a child with a serious allergy, add an allergy action plan. This form is not legal or medical advice. Check your state's licensing rules for the exact wording required.
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Common questions
What is a child care emergency form?
A form parents sign that lets the center call 911 and get emergency medical treatment for their child when the parent cannot be reached. It also lists insurance, the child's doctor, allergies, medical conditions and medicines.
Is an emergency medical consent form required in child care?
Most state licensing rules require centers and family child care homes to have a signed emergency medical authorization on file for every child. Check your state's rules for exact requirements.
Is this the same as an emergency contact form?
No. An emergency contact form lists who to call and who may pick up. This form gives permission for emergency medical care. Many centers use both.
How often should parents update the emergency form?
At least once a year, and any time phone numbers, insurance, the doctor or the child's health needs change.
Is this child care emergency form free?
Yes. Add your center details, turn sections on or off and download a printable form for each family.