Emergency Care Form
Please fill out the fields below and click submit to send this information to
the White River School District Nurse.
, hereby authorize the White River School District to allow my child,,
to receive emergency medical care at the Mellette County Health Clinic if I or
a family member can not be reached in case of accident, injury, or severe
illness at school.
For the doctor or physician assistant's information, my child is allergic
to the following food or medications:
Parent (s) or Legal Guardians (s)
For School Use Only: