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Consent for Emergency Medical Treatment California: LIC 627 Mobile App

When your child is away from home, it may be necessary to give parental consent for medical decision-making to the professionals tending to your child.

The Child Care Consent for Emergency Medical Treatment for California: LIC 627 mobile app is designed to be used by parents or legal guardians to give child care providers informed consent to seek emergency medical treatment or medical services for their child in the State of California. The app is available for an iPhone, iPad, or Android device and includes the complete information for consent form LIC 627.

The information you enter is always securely accessible on the GoCanvas Cloud and be emailed as a PDF to your child's other health care professionals to keep with their medical records.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Consent for Emergency Medical Treatment California: LIC 627 Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Child Care Centers Or Family Child Care Homes

  • Ico statictext

    AS THE PARENT OR AUTHORIZED REPRESENTATIVE, I HEREBY GIVE CONSENT TO

  • Ico textbox

    FACILITY NAME

  • Ico statictext

    TO OBTAIN ALL EMERGENCY MEDICAL OR DENTAL CARE PRESCRIBED BY A DULY LICENSED PHYSICIAN (M.

  • Ico textbox

    NAME

  • Ico statictext

    THIS CARE MAY BE GIVEN UNDER WHATEVER CONDITIONS ARE NECESSARY TO PRESERVE THE LIFE, LIMB OR WELL...

  • Ico multiline

    CHILD HAS THE FOLLOWING MEDICATION ALLERGIES:

  • Ico textbox

    PARENT OR AUTHORIZED REPRESENTATIVE

  • Ico multiline

    HOME ADDRESS

  • Ico textbox

    HOME PHONE

  • Ico textbox

    WORK PHONE

  • Ico signature

    PARENT OR AUTHORIZED REPRESENTATIVE SIGNATURE

  • Ico date

    DATE

  • ...and More!

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