Emergency Medical Treatment Consent Form

In the event of an emergency, when I cannot be reached, I authorize the administration of any medical procedures necessary by my doctor, or if unavailable, by any other doctors selected by my child's daycare provider.  I authorize for my child's daycare provider to call for an ambulance in an emergency before I am contacted to help provide treatment as soon as possible to my child.


Date:______________________________



Parent's Signature:_____________________________



Health card number:____________________________
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