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Parental Consent for Deworming

The document contains a medical permission form for Gabu Elementary School. The form provides spaces for the child's name, grade, age, and type of medical treatment required. Parents are asked to print their name and sign the form giving permission for their child to receive deworming medicine. Multiple copies of the same form are provided.

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rosana
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323 views1 page

Parental Consent for Deworming

The document contains a medical permission form for Gabu Elementary School. The form provides spaces for the child's name, grade, age, and type of medical treatment required. Parents are asked to print their name and sign the form giving permission for their child to receive deworming medicine. Multiple copies of the same form are provided.

Uploaded by

rosana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

PERMIT PERMIT

School:Gabu Elementary School School:Gabu Elementary School


Date: ___________________ Date: ___________________

I hereby give permission to ____________________________, I hereby give permission to ____________________________,


(Name of a Child) (Name of a Child)
______ Grade ___________ ______ Grade ___________
(Age) (Age)
To receive medical treatment: (Pls. Check) To receive medical treatment: (Pls. Check)
______deworming medicine ______deworming medicine

______________________________ ______________________________
Print name/Signature of Parent Print name/Signature of Parent

PERMIT PERMIT
School:Gabu Elementary School School:Gabu Elementary School
Date: ___________________ Date: ___________________

I hereby give permission to ____________________________, I hereby give permission to ____________________________,


(Name of a Child) (Name of a Child)
______ Grade ___________ ______ Grade ___________
(Age) (Age)
To receive medical treatment: (Pls. Check) To receive medical treatment: (Pls. Check)
______deworming medicine ______deworming medicine

______________________________ ______________________________
Print name/Signature of Parent Print name/Signature of Parent

PERMIT PERMIT
School:Gabu Elementary School School:Gabu Elementary School
Date: ___________________ Date: ___________________

I hereby give permission to ____________________________, I hereby give permission to ____________________________,


(Name of a Child) (Name of a Child)
______ Grade ___________ ______ Grade ___________
(Age) (Age)
To receive medical treatment: (Pls. Check) To receive medical treatment: (Pls. Check)
______deworming medicine ______deworming medicine

______________________________ ______________________________
Print name/Signature of Parent Print name/Signature of Parent

PERMIT PERMIT
School:Gabu Elementary School School:Gabu Elementary School
Date: ___________________ Date: ___________________

I hereby give permission to ____________________________, I hereby give permission to ____________________________,


(Name of a Child) (Name of a Child)
______ Grade ___________ ______ Grade ___________
(Age) (Age)
To receive medical treatment: (Pls. Check) To receive medical treatment: (Pls. Check)
______deworming medicine ______deworming medicine

______________________________ ______________________________
Print name/Signature of Parent Print name/Signature of Parent

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