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An of my child/ren 1. To have the care, custody and control of my child/ren: Name: Date of Birth: Name: Date of Birth: Name: Date of Birth: Name: Date of Birth: and do all things necessary to properly care for my said child/ren: 2. To consent to and authorize any and all medical treatment necessary for the properly care and well-being for my child/ren. 3. To consent to and authorize any and all actions necessary for the proper care of my child/ren as regards to her/his/their attendance a.

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