• As legal custodian of student(s) for which you are acknowledging receipt of this handbook, you hereby authorize Millbrae Elementary School District officials and or designees, into whose care the minor pupil has been entrusted to consent to an X-ray, examination, anesthetic, medical or surgical diagnosis, treatment, and/or hospital care to be rendered to said minor that are considered necessary in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services. I understand that this authorization is given in advance of any required diagnosis, treatment, or hospital care and provides authority and power to the aforementioned officials or designees to give specific consent to any and all such diagnosis, treatment, or hospital care which a licensed physician or dentist may deem necessary. This authorization shall remain effective for the full school year unless revoked in writing and delivered to said officials and/or designees.  I understand that the Millbrae Elementary School District, its employees and its Board assume no liability of any nature in relation to the transportation or treatment of the said minor.  I further understand that all costs of paramedic transportation, hospitalization, and any examination, X-ray, or treatment provided in relation to this authorization shall be my responsibility.  I understand that the Millbrae Elementary School District does not provide accident medical insurance for students for school related injuries but does offer student accident insurance for voluntary purchase.

    The Millbrae Elementary School District does not provide medical, accident or dental insurance for pupils injured on school premises or through school activities. In accordance with Education Code Section 49472, the District is making available a low cost medical/dental accident insurance program through Pacific Educators.