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Medical Emergency Procedures, Emergency Contacts, and Waiver of Liability

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It is mutually agreed that in the event of an accident or illness of my child while in the care of the teachers and assistants (the Staff) of the Polish School of Atlanta, the Staff should use their best efforts to contact the parents or guardians immediately. If the parents or guardians cannot be reached immediately, the Staff will use their best efforts to contact the emergency numbers provided by the parents/guardians (primarily the child’s doctor). In the event that a parent, a guardian, and an emergency contact are not immediately available, the Staff is authorized to provide such care as the situation may reasonably warrant.


The parents and guardians agree that the Staff of the Polish School of Atlanta act in good faith to comply with the accident and illness procedures and that neither the members of Staff nor the School shall be liable for the accident and/or illness of the child. Any and all liability as might otherwise exist is expressly waived by the parent/guardian.


Name/ Name's of the children attending the Polish Club of Atlanta

Names and surnames of parents and guardians

Selecting the below field means you agree to this declaration and that you signed it

Emergency contact other than parents or guardians

Health Insurance Company and group number

The Child's doctor - name and phone number

Clicking on "Submit document and sign it" will send it automatically to our mail address

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