Explorer Academy Waiver of Release of Claims Consent for Emergency Medical Services Form (18 yrs or older) Rev 01 09 pdf
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Mandala Childrens House 2010-2011 5038 Hyland Ave San Jose, CA 95127 Tel 408 251-8633 Fax 408 251-8697 CONSENT for EMERGENCY MEDICAL TREATMENT Medical Release.
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CONSENT FOR EMERGENCY MEDICAL TREATMENT I We , the undersigned parents, agency representative or legal guardian of _______ Name of Child a minor, do hereby authorize.
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and Health Record 2012-2013 I, the undersigned parent/guardian of a minor, do hereby consent to x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital services.
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