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Emergency Card Information

Date of Birth
Month
Day
Year

INSTRUCTIONS TO REACH PARENT/GUARDIAN:

PEDIATRICIAN OR SOURCE OF HEALTH CARE

MEDICAL EMERGENCY TREATMENT

I hereby give

permission to administer basic first aid and/or CPR to my child

and/or take my child

to a hospital for medical treatment when I cannot be reached or when delay would be dangerous to my child's health.

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Date
Month
Day
Year

INSURANCE INFORMATION (OPTIONAL)

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