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Get and Sign Fraser Health Registration Child Care Form 2013-2022
LOCATION
TELEPHONE (Include Local / Extension)
(
)
TELEPHONE (Include Local / Extension)
(
)
CELL PHONE / PAGER
(
CELL PHONE / PAGER
(
)
HOURS AT THIS LOCATION
)
HOURS AT THIS LOCATION
EMERGENCY HEALTH INFORMATION
CARE CARD NUMBER
FAMILY DOCTOR / CLINIC NAME
DOCTOR / CLINIC TELEPHONE
(
)
CONSENT FOR EMERGENCY CARE
I authorize the staff at the child care centre to call a medical practitioner or ambulance / transport
child to emergency medical care, in the case of accident or illness...
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