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Emergency Medical Authorization


suffer any injury or illness

while in the care of ENRICHMENT STATION and the facility is unable to contact me (us) immediately, it shall be authorized to secure such medical attention and care for the child as may be necessary.  I (we) shall assume responsibility for payment for services.


I (we) agree to keep the facility informed of changes in telephone numbers, emergency contacts, and where I can be reached.


The facility agrees to keep me informed of any incidents requiring professional medical attention involving my child.  In the event my child should require professional medical attention while in the care of the center, I understand that my child will be transported to the nearest medical facility, which is:

Dekalb Medical Center

2701 North Decatur Road

Decatur, GA  30033

(404) 501-1000

My child's primary source of health care is:

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