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Kid's Place at Sequoyah, Inc.

2015-2016 Health Form

Many hospitals and doctors will not treat a child without parental consent (unless a matter of life or death). DHS and KP require that you complete the information below so that if your child requires a visit to the hospital while under the supervision of Kid’s Place, the hospital will be able to treat the injury. Every effort will be made to contact the parents/guardians prior to treatment. If your child is not immunized for religious or medical purposes, documentation from a medical professional is required.