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12/19/2019

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Parent/Guardian Consent to Medical, Dental or Hospital Care

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Parent/Guardian Consent to Medical, Dental or Hospital Care

Designed for seamless integration into your organizational procedures, this form ensures authorized medical actions and financial responsibility.

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Church Mutual Insurance Company, S.I. (a stock insurer) | P.O. Box 357 | 3000 Schuster Lane | Merrill, WI 54452-0357 | Telephone (800) 554-2642 or (715) 536-5577
© Church Mutual Insurance Company, S.I. All rights reserved. Protecting the Greater Good is a registered trademark of Church Mutual Insurance Company, S.I.

¹ Church Mutual is a stock insurer whose policyholders are members of the parent mutual holding company formed on 1/1/20. S.I. = a stock insurer.