Mom's Day Out & Preschool
4007 Airline Drive
Bossier City, La 71111
318-746-2799

Emergency Conact/ Medical Information

I authorize all medical and surgical treatment, X-Ray, laboratory, anesthesia, and other medical and/ or hospital procedures as may be performed or prescribed by the attending physician and/ or paramedics for my child and waive my right to informed consent of treatment.  This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency.