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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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