In the event that I am unable to be reached and my child requires medical, dental or surgical treatment while in the care of Girls Inc. of Sioux City, I hereby grant permission to the hospital, doctor, dentist or their designees to administer such medical, dental or surgical care/treatment as may be appropriate or deemed necessary. I agree to pay all costs and fees resulting from any such emergency medical, dental, or surgical care/treatment for my child as secured or authorized under this consent.
This consent shall remain in effect from the date submitted until such time as my child is no longer enrolled with Girls Inc. of Sioux City.
COMMENT: Every effort will be made to notify parents/guardians immediately in case of emergency.
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