American legion auxiliary department of california california girls state 2nd alternate application district# unit # unit name chairman address e-mail phone nd 2 alternate name date of birth mailing address city ca, zip email nd parent(s)/legal...
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Annual permission form october 1, 20 to september 30, 20 info girlscoutsnrcal.org .girlscoutsnorcal.org complete this form at time of registration. this form will be retained by the troop/group leader. name of girl scout member id address home...
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Global outreach international, inc. po box 1, tupelo, ms 38802 (mailing) 74 kings hwy, pontotoc, ms 38863 (physical) (662) 842-4615 .globaloutreach.org dear team leader/member, 09-05-14 thank you so much for taking the responsibility of making...
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Student immunization form student name birthdate student number minnesota law requires children enrolled in school to be immunized against certain diseases or file a legal medical or conscientious exemption. for school use only ( ) complete;...
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Lhsaa medical history evaluation important: this form must be completed annually. kept on file with the school, & is s ubject to inspection by the rules compliance team. please print code: family medical history: has any member of your family...
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Medical record - consent form authorization to send and receive medical information by electronic mail for use of this form see, medcom supplement 1 to ar 40-66; the proponent agency is mcho section i - patient data 1. name (last, first, middle...
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! !! ! medical consent form name age birth date ! mailing address ! home phone ! school current grade ! street city state zip code to whom it may concern: the undersigned does hereby give permission for our (my) child, to attend and participate in...
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Westminster presbyterian church 2015 calvin fellowship medical consent form name age birth date mailing address street city state zip code phone numbers social security number current grade to whom it may concern: the undersigned does hereby give...
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Medical release form for minors attending with a guardian name of minor child: age: date of birth: we, the undersigned parent(s) or legal guardian(s) of the above-named minor, know that i may not be available to authorize medical care of said...
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Parental access to the online medical record of a patient 14 to 17years oldonline submission requirements and proceduresbirth/adoptive parents or legal guardians can access the online medical record for theirchildren who are 14-17 years old by...
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Utb/tsc r.e.k. sports camp 2011 registration form please select one: session 1: june 27 july 1 (registration deadline is monday, june 20). session 2: july 11 july 15 (registration deadline is tuesday, july 5). session 3: july 25 july 29...
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Emergency treatment consent form .padi.com i affirm i am the parent and/or legal guardian of . name of minor as the parent/guardian, i hereby authorize , and/or its (dive center/resort/instructor) agents, employees or assigns, to seek medical...
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Instructions forparental/guardian approval forminor to travel and medical authorizationif one legal parent is traveling outside the united states with aminor child, this form should be signed by the legal parent that isnot traveling.if a minor...
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Parental consent forms for minor children traveling without both birth parents in addition to the child's citizenship documentation, a minor child under the age of 18 must have a legal guardian, or parental consent form from their birth parents to...
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A separate copy of this form must be completed for each child applying to tei early childhood programs tulsa educare, inc. child application form print form head of household: child's name: child's preferred name: this child lives with: one parent...
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