Form CY867 Emergency Contact Parental Consent Form - Pennsylvania

This version of the form is not currently in use and is provided for reference only. Download this version of Form CY867 for the current year.

Form CY867 Emergency Contact Parental Consent Form - Pennsylvania

What Is Form CY867?

This is a legal form that was released by the Pennsylvania Department of Human Services - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the purpose of the CY867 Emergency Contact Parental Consent Form?
A: The CY867 Emergency Contact Parental Consent Form is used to authorize emergency medical treatment and provide contact information for a child in Pennsylvania.

Q: Who needs to fill out the CY867 form?
A: This form should be filled out by the parent or legal guardian of a child residing in Pennsylvania.

Q: Is the CY867 form mandatory?
A: Yes, it is mandatory for parents or legal guardians to complete the CY867 form for their child in Pennsylvania.

Q: What information is required on the CY867 form?
A: The CY867 form requires information such as the child's personal details, emergency contact information, and consent for emergency medical treatment.

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Form Details:

  • Released on January 1, 1993;
  • The latest edition provided by the Pennsylvania Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CY867 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Human Services.

Download Form CY867 Emergency Contact Parental Consent Form - Pennsylvania

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