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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:



    Do you have ambulance insurance?

    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.