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Student Information

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Emergency Medical Release

The purpose of this form is to give permission to the Pats Peak Ski Patrol, any responding ambulance service and/or Concord Hospital to provide emergency treatment for your child in the event of an illness or an injury. In the event of a serious injury or illness, every attempt will be made to contact the legal guardian listed below at the phone number listed. Emergency medical treatment however, will not be delayed while trying to make this contact.

(name of the ADULT person who is present)

(name of minor)

* NOTE: At least one phone number above must be provided.

In the event of multiple persons being given permission, on first line above, write: (Any person listed below)

 * I verify that I am the parent or guardian of the minor and I have read and understand the information on the emergency medical form. All the information I have provided is true and complete.