Please email firstname.lastname@example.org a copy of the student's health insurance card (both sides of card please).
Write "Not Applicable" for any information that does not apply to your family.
Relative, (not parent), friend, and/or neighbor who may be contacted if parent cannot be reached:
ROUTINE CARE - I hereby give permission to Foxman Torah Institute aka Delaware Valley Torah Institute to administer
first-aid care in emergency situations and to give my child(ren) Tylenol (acetaminophen), Ibuprofen, over-the-counter allergy
medicine, and/or any other common household remedies when necessary.
I (parent or guardian), the undersigned, do hereby authorize FOXMAN TORAH INSTITUTE aka Delaware Valley Torah
Institute as our general agent to any emergency care deemed advisable and to be rendered through general or specific
supervision of any licensed physician or surgeon. It is understood that this authorization is given in advance of any specific
need for treatment and is given to provide the authority to the aforesaid agent to give specific consent to any and all
emergency treatment or hospital care which the physician in the exercise of his best judgment may deem advisable.