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Christ The King Catholic Church
MAILING ADDRESS: P.O. Box 95, Acme, MI 49610
SITE/GPS: 3801 Shore Road, Williamsburg
EMAIL: generalmail@christkingchurch.org
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Home
Parish Life
Mass & Confession Times
Newcomers
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Catholic Services Appeal
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Knights of Columbus
Parish Groups & Councils
Instructions: Returning to Mass Safely
Faith Formation
Faith Formation Program Registration
Confirmation and First Communion Request Form
Becoming Catholic - RCIA
The Sacraments
Vocations
CORPORAL WORKS OF MERCY
Ministry
Liturgical Ministry
Community Ministry
Music Ministry
News
Announcements
Bulletin
Photo Albums
CTK Parish Pictorial Directory
Calendar
Videos
MEDICAL TREATMENT RELEASE FORM
Faith Formation
Faith Formation Program Registration
MEDICAL TREATMENT RELEASE FORM
Confirmation and First Communion Request Form
Becoming Catholic - RCIA
The Sacraments
Vocations
CORPORAL WORKS OF MERCY
The maximum number of form submissions has been reached. This form is currently not available.
To Whom It May Concern:
As a parent/guardian I do hereby authorize the treatment by a qualified and licensed Medical Docctor in an emergency which, in the opinion of the attending physician, may endanger his/her 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.
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I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice of Privacy Rights that may be presented by the physician or health care facility.
This authorization is completed and signed of my own free will with the sole purpose of authorizing medical treatment deemed necessary and appropriate by the treating physician.
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