Early Childhood Services Emergency Card
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ECS Emergency & Medical Health Record

  • MM slash DD slash YYYY
  • I hereby authorize my child to be released to any of the following people (must be 16 years of age or older). I understand that: 1. The child will be released only to the parent/guardian or person authorized for child's release. 2. The parent/guardian or authorized person may be asked for a picture ID before the child is released to them. I, the undersigned parent or guardian, hereby give my consent, in the event of an emergency when I cannot be contacted for the above named child to be taken to the hospital. I have named above for treatment by the physician in the emergency room. I hereby consent to having information on this card available in the classroom.
  • MM slash DD slash YYYY
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