Full Text
CONSENT FOR EMERGENCY MEDICAL/DENTAL CARE I hereby give consent for any emergency medical/dental care and/or surgery as needed and recommended by a duly licensed physician and/or dentist for my child(ren): While my child(ren) is (are) in day care at the licensed child care home of I understand that I will be notified as soon as possible of any major medical or surgical care needed. (Witness) (Parent) (Maternal Grandparent if Mother is under 18) Dated this of 20___ EMERGENCY NUMBERS MOTHER AT FATHER AT GRANDPARENT/CLOSE RELATIVE OR FAMILY CHILD(REN) CHILD(REN) 08/2011