Levittown AM Program - Levittown Public Schools
Levittown AM Program - Levittown Public Schools
Levittown AM Program - Levittown Public Schools
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LEVITTOWN PUBLIC SCHOOLS<strong>Levittown</strong> Memorial Education CenterAbbey Lane<strong>Levittown</strong>, New York 11756“SUCCESS FOR EVERY STUDENT”Mike Gattus<strong>Levittown</strong> A M <strong>Program</strong> Coordinator(516)520-1342LEVITTOWN A M PROGR<strong>AM</strong>MEDICAL EMERGENCY FORMI ____________________________________________ give permission to the Teacher-in-charge ofthe <strong>Levittown</strong> A M <strong>Program</strong> to administer minor first aid only (apply sterile bandages to cuts andice to bumps) to my child ___________________________________.(Please print neatly)In the event of a medical emergency, if I, or the emergency contact persons, I have listed cannot bereached, I authorize the Teacher-in-Charge of L<strong>AM</strong>P to take the necessary steps to provide medicaltreatment for my child including authorizing emergency medical treatment at a hospital.________________________________Parent/Guardian signature_______________________________Date_______________________________Medical Insurance Carrier________________________________Phone #________________________________ID #
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