I hereby give my consent for emergency Medical or Dental Treatment of my daughter and/or son (listed above) by a licensed physician or dentist while under the care of LCAA Head Start and for transporting of the student to and from the source of Emergency Treatment at the above Facility.
The Treatment may include examination and any test deemed necessary by the Physician or Dentist. Surgical operations without prior consent will not be administered of emergency, after several attempts have been made to contact me; until I become available.
This consent is valid for two years after the date signed.