Medical & Emergency Authorization

1. Purpose

This authorization ensures that Roots and Wings WNC Program leaders have the information needed to respond to a medical situation involving your child(ren) during Program activities. Because this is a parent-present program, the parent or legal guardian remains primarily responsible for the child’s medical needs during each session. All medical information provided through the registration form is kept confidential and used only for emergency purposes.

2. Emergency Contact Information

During registration, you will be asked to provide:

• Primary emergency contact — name, phone number, and relationship to the child
• Secondary emergency contact — name, phone number, and relationship to the child

Please ensure your emergency contacts are reachable during Program hours (Wednesdays, 10:00 AM – 12:00 PM).

3. Medical Information

During registration, you will be asked to disclose any relevant medical information for each child, including:

• Known allergies (food, insect, environmental, or medication)
• Chronic conditions (asthma, diabetes, seizure disorders, etc.)
• Current medications
• Any physical limitations or special needs

It is the parent/guardian’s responsibility to keep this information current. If your child’s medical situation changes during the session, please notify Program leaders immediately at rootsandwingswnc@gmail.com.

4. Consent to Emergency Treatment

In the event of a medical emergency, I understand that Program leaders will first attempt to locate me or the child’s attending parent/guardian on-site immediately. If immediate action is necessary and I cannot be reached without delay, I authorize Roots and Wings WNC Program leaders to:

• Administer basic first aid
• Contact emergency medical services (911)
• Authorize emergency medical treatment by qualified medical personnel
• Transport or arrange transport of my child to the nearest medical facility

I understand that Program leaders are not medical professionals and that this authorization is for emergency situations only. Program leaders do not diagnose, prescribe, or provide medical treatment beyond basic first aid and emergency response.

5. Medication Administration

Program leaders do not administer, store, or manage medication. Because a parent or guardian is expected to remain on-site during the program, any medication needed during Program hours (including an EpiPen or inhaler) must remain with the parent/guardian or with the child only under the parent/guardian’s direct responsibility.

• If your child self-carries medication, you remain responsible for that decision and for ensuring your child can access it safely.
• If medication may be needed during a session, the parent/guardian should keep it on their person and administer it directly if needed.

Please inform Program leaders of any emergency medication your child may have during the session and whether it is being carried by the child or held by the parent/guardian.

6. Notification & Emergency Response

If a child becomes ill or injured during a session, Program leaders will:

1. Administer basic first aid if appropriate
2. Notify the parent/guardian on-site immediately, or use the emergency contact numbers provided if the parent/guardian cannot be located without delay
3. Call 911 if the situation requires immediate medical attention

Parents/guardians remain responsible for deciding whether their child should continue participating after illness or injury and for taking over care once notified.

7. Acknowledgment

By completing the Roots and Wings WNC registration form, I confirm that I have read, understood, and agree to this Medical & Emergency Authorization. I certify that the medical information I have provided is accurate and complete, and I accept responsibility for updating it as needed.