WAITLIST: SRCOC Tuesday School Emergency Medical Form

Please fill out this form and click submit. You will receive an email confirmation of your submission.
Please be sure to also fill out the Tuesday School Enrollment Form on the Tuesday School page. Your child's enrollment is not complete until both forms are received by our office.
Enrollment fees are due at Orientation Day, the week before the school year begins.
If you have any questions, please email office@springroadcoc.com, or call 614-882-1900.
YOU ARE FILLING OUT A WAITLIST EMERGENCY MEDICAL FORM FOR SRCOC'S TUESDAY SCHOOL. Our enrollment for the 2026-2027 school year is full. The way the waitlist works: if a spot opens up, the first person on the waitlist will be given the chance to enroll; if a second spot opens, the second person on the waitlist will be given the chance to enroll, etc. Please contact the office to learn your number on the list (614-882-1900 or office@springroadcoc.com)

You may also fill out a PDF or hard copy form and submit it to the church office, either via email or post, or drop it off in-person at the building.
https://drive.google.com/file/d/1z1KjY7RTnKTh-hb56fpFcINn07rMQz_N/view?usp=drive_link
Please select all that apply.
Purpose: To enable legal guardians to authorize emergency medical treatment for children who become ill or injured while at Tuesday School, after reasonable attempts to reach the child’s legal guardian(s) have not been successful.
 
 
 
 
 
In the event a Tuesday School representative is unable to contact:
 
at the number listed below:
 
or the other parent or legal guardian listed here:
 
at the number listed below:
 
then I give my consent for the administration of any treatment deemed necessary by my child's physicians, listed below:
 
 
 
 
Or, if niether physician are available, then by another licensed physician or dentist at the same practice, and/or the transfer of my child to the preferred hospital listed, or any hospital reasonably accessible:
 
Please list any other facts concerning your child's medical history to which a physician should be alerted or of which we should be made aware (including allergies, medications currently being taken, and physical impairments):
 
 
 
 
 
 
 
 

Description

Please fill out this form and click submit. You will receive an email confirmation of your submission.
Please be sure to also fill out the Tuesday School Enrollment Form on the Tuesday School page. Your child's enrollment is not complete until both forms are received by our office.
Enrollment fees are due at Orientation Day, the week before the school year begins.
If you have any questions, please email office@springroadcoc.com, or call 614-882-1900.