Free Child Care Medical Authorization Form Template

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Free Child Care Medical Authorization Form Template

Child Care Medical Authorization Form

Please complete this form to grant medical authorization for your child while under the care of a caregiver.

Child's Information

Name

    Date of Birth

      Allergies/Medical Conditions

        Medications

          Parent/Guardian Information

          Name

            Phone number

              Email

                Emergency Contact Information

                Name

                  Phone number

                    Relationship to Child

                      Medical Authorization

                      I hereby grant permission for my child to receive medical treatment in case of an emergency while under the care of the designated caregiver. I authorize the caregiver to seek medical attention, including calling an ambulance or taking my child to the nearest hospital if necessary.

                      Parent/Guardian Name:

                      Date:

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