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Get and Sign Consent for Emergency Dental and Medical Form Pope County Co Pope Mn

Or their designee. I understand that every possible effort will be made to contact me in the event that any emergency medical, dental, or surgical care is needed for my child as recommended by licensed medical and dental personnel. The names of my children are as follows: Parent Signature & Date: _______________________________ Parent Signature & Date: _______________________________ Child Care Provider Signature & Date: _____________________ AN EQUAL OPPORTUNITY...

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