AS THE PARENT OR AUTHORIZED REPRESENTATIVE, I HEREBY GIVE CONSENT TO Upward Bound Preschool & LCOS TO OBTAIN ALL EMERGENCY MEDICAL OR DENTAL CARE FACILITY NAME PRESCRIBED BY A DULY LICENSED PHYSICIAN (M.D.) OSTEOPATH (D.O.) OR DENTIST (D.D.S.) FOR my children (named above) . THIS CARE MAY BE GIVEN UNDER NAME WHATEVER CONDITIONS ARE NECESSARY TO PRESERVE THE LIFE OR LIMB.
