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CCL 010 Rev. 7/2012 Kansas Department of Health and Environment Bureau of Family Health 1000 SW Jackson Suite 200 Topeka KS 66612-1274 Child Care Unit Phone 785-296-1270 Fax 785-296-0803 Foster Care Unit Phone 785 296-1270 Fax 785 296-7025 Website www. kdheks. gov/kidsnet/ Consult local hospital to be sure this form is acceptable. Written permission of the parent guardian or legal custodian for emergency medical treatment must be on file at facility for each child on a form that meets the requirements of the hospital or clinic where emergency care will be given* License or Certificate In order to meet all legal requirements I hereby authorize and/or who is are representative s of Child Care Facility to give consent for any and all necessary emergency medical care for my child Name while said child is in said individual s custody between the dates of and Month Day Year Signature of Parent or Guardian Parent s signature needs notarization or witnessed if required by local hospital or cli....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232