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Get Msysa Medical Release Form

Ll medical attention necessary to be administered to my child, (INSERT CHILD S NAME) In the event of accident, injury, sickness, etc., under the direction of the person(s) listed below, until such time as I may be contacted, this release is effective for a period of one year from the date given below. I also assume the responsibility for the payment of any such treatment, including, but not limited to transportation for required treatment. Parent/Guardian: Relationship: Address: City/State/Zi.

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