(revised 01.01.2020)
11. Acknowledge that I have read, understand and agree to hereby give consent to assess, treat and test my child.
I have read and understand the above information. I have been informed of my responsibilities and I understand them fully.This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California.This authorization shall remain effective until 1 January, 2030, unless sooner revoked in writing and delivered to said agent.
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