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Download - ...Person to contact in case of emergency Phone Number I authorize release of any information conceming my (or my child's) health care, advice and treatment for the purpose of evaluating

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Page 1: ...Person to contact in case of emergency Phone Number I authorize release of any information conceming my (or my child's) health care, advice and treatment for the purpose of evaluating

Page 2: ...Person to contact in case of emergency Phone Number I authorize release of any information conceming my (or my child's) health care, advice and treatment for the purpose of evaluating

Page 3: ...Person to contact in case of emergency Phone Number I authorize release of any information conceming my (or my child's) health care, advice and treatment for the purpose of evaluating

Page 4: ...Person to contact in case of emergency Phone Number I authorize release of any information conceming my (or my child's) health care, advice and treatment for the purpose of evaluating

Page 5: ...Person to contact in case of emergency Phone Number I authorize release of any information conceming my (or my child's) health care, advice and treatment for the purpose of evaluating

Page 6: ...Person to contact in case of emergency Phone Number I authorize release of any information conceming my (or my child's) health care, advice and treatment for the purpose of evaluating

Page 7: ...Person to contact in case of emergency Phone Number I authorize release of any information conceming my (or my child's) health care, advice and treatment for the purpose of evaluating

Page 8: ...Person to contact in case of emergency Phone Number I authorize release of any information conceming my (or my child's) health care, advice and treatment for the purpose of evaluating

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KM C224e-20151111235304 · · 2017-04-10received and read the letter regqrding videotaping in my child's class. My ... participates in a class I DO NOT give my permission to include