Torah Center Medical Form

Please provide any information that can help us meet your child's needs. ALL INFORMATION IS CONFIDENTIAL.
  • If yes, please provide an Epi-Pen and an allergy action plan to the Education Office.
  • If I cannot be reached in the event of an emergency, I give permission to the physician selected by our Torah Center staff to hospitalize, secure proper treatment for, and order injection, anesthesia or surgery for my child.
  • IF YOU HAVE INDICATED THAT THIS CHILD HAS A SERIOUS MEDICAL CONDITION, PLEASE MAKE CERTAIN THAT EMERGENCY MEDICINE IS LEFT IN THE TORAH CENTER OFFICE WITH PRECISE INSTRUCTIONS SIGNED BY YOU.