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King's Kids Consent for Medical Treatment 

Please fill out the following form.

Parent's or Legal Guardian's Info
Child's Info
Doctor's Info

We hereby grant my/our permission for King's Kids Learning Center, who is caring for my child during my/our absence, to seek medical care for the above named minor when he/she finds it to be necessary. The medical care shall cover illness, accident or injury. In the event of Emergency Department care, when consultation or follow-up care is required, it is my/our preference that the following Doctor be contacted at the following number.

Parent/Legal Guardian Signature
Parent/Legal Guardian Signature

Thanks for submitting!

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