Page 2 of 3FIELD TRIP EXHIBITMEDICAL RELEASE FORM ● EXTENDED FIELD TRIP In the event of an emergency, my signature below constitutes permission for my child to receive medical evaluation and necessary treatment to ensure his/her safety.
Such treatment may come from either my child’s physician or another physician or medical facility as deemed appropriate by the supervising Wayne Central staff member.
As my Attorney In Fact, I give the supervising Wayne Central staff member my permission to execute any necessary documents in connection with the medical treatment including any required guarantee of payment.
Parent/Legal Guardian’s insurance carrier:………...
Allowed
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ctewinkle
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EduTech School Districts 
