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Areas Marked With An * Must Be Filled Out - (Information is kept confidential)

It is the policy of this centre to notify a parent when a child is ill or needs medical attention. In the event we cannot contact you and we need to get immediate help for your child, we require a signed consent to do so.

1. I give consent for my child to be taken to the nearest emergency medical centre when I cannot be contacted.

2. I give consent for my child to receive medical treatment.

Personal information contained on this form is collected under the Community Care and Assisted Living Act and will be used only for the purpose indicated.