HEALTH CARE FORM YOUTH'S NAME: DOB GENDER MEDICAL DETAILS I give permission for WCYS to seek medical and/or dental attention for my child as required: YesNo Do you have ambulance insurance? YesNo NOTE: If there is a medical emergency, parents/carers are expected to meet the cost of an ambulance. List any essential information that could affect your child in an emergency e.g. allergy to penicillin: Health Care Form completed by: When you submit this form a copy of the form will be sent you your email address.