EMERGENCY MEDICAL CONSENT FORM MY INSURANCE PROVIDER IS First PREFERRED HOSPITAL/TREATMENT CENTERMY CHILD HAS THE FOLLOWING ALLERGIESMY CHILD IS TAKING THE FOLLOWING MEDICATIONSMY CHILD HAS THE FOLLOWING ALLERGIESI UNDERSTAND THAT I ASSUME ALL FINANCIAL RESPONSIBILITY FOR ANY TREATMENT OR INJURIES SUSTAINED BY MY CHILD WHILE HE/SHE IS IN CHILD CARE.Date MM slash DD slash YYYY
