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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.