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Neptune Township Medical Authorization Form As a parent and/or guardian of child s name a minor I hereby authorize the treatment by a qualified and licensed medical doctor in the event of a medical emergency which in the opinion of the attending physician may endanger my child s life cause disfigurement physical impairment or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. Name of Parent/Guardian Address City State Zip code...
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