Spring training registration complete forms (one per participant), sign release and send with payment to andy chong, po. box 22, clinton, ma 01510 by april 1, 2014. name: email address: city/town: state: zip: home phone :( ) cell phone:( ) date of...
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Dear parentscollege sporting scholarshipthis scholarship is an effort to support a student and his family where sporting talent has been obviousor potential is obvious. the scholarship will be awarded for 2016/17 to a student who excels at one...
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Authorization for minor 's medical treatment child name: birthdate: age: grade in school: doctor (or hmo): address: phone: medical insurer/health plan: policy no.: allergies (medications): allergies (other): conditions for which child is currently...
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Worksheet a grade 1 beat the bomb name date 1 add the missing letters. a f n keeps us cool in summer. i see little tiger c bs at the zoo. ( a or u ) jack ch ps the wood for the re. ( e or o ) ice cream will m lt in the sun. 2 ( i or a ) ( u or e )...
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325 tamarack lane / shiloh, il 62269 / (618) 624-2060 / fax (618) 624-6 / .aaicenter.org / info aaicenter.org consent to treat minors form the allergy, asthma & immunology center, sc (aaic) requires a parent or legal guardian to be present at the...
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Consent for medical treatment (minors only) i, , am the parent or legal guardian of and i authorize (name of program) to obtain emergency medical treatment of this minor by an appropriate health care professional should the need arise while he/she...
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Name grade 6 ring of fire journal page analysis and interpretation worlds smallest ocean date miniocean # *key* 1. what features are present in your miniocean? answers will vary. 2. could you have missed a feature? explain. yes. probes only go in...
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Medical release form in the event of illness, medical emergency, or injury occurring to my child while under the care of (babysitter or other caregiver), i consent for appropriate fire department and emergency medical services staff or their...
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The medical center babysitting clinic application form first name last name street address city state zip code phone number ( ) age (11-17) t-shirt size preferred: (youth sizes) (adult sizes) small small medium medium sex: male large large x-large...
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For immediate release contact: michael gerard 216-288-5060 michael 4inhomecare.com .sittercafe.com web-based service protects babysitters chagrin falls, ohio - the sitter cafe, an established innovator in the growing online sitter search industry,...
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Milwaukee, wisconsin site: consent for treatment of a minor i "we" the undersigned parent / guardian of: a minor, do hereby consent to and authorize any medical provider of aurora health care to provide necessary care / treatment to said minor...
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Return completed form to: university of wisconsin oshkosh student health center student health center university of wisconsin oshkosh 800 algoma blvd., radford hall oshkosh, wi 54901-8694 consent for medical treatment of a minor i, , being the...
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Child personal information for babysitter name: dob: height: mother name: street address: city: work phone: home phone: cell phone / pager: father name: street address: city: work phone: home phone: cell phone / pager: other contact: street...
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203 west 29th street, lumberton, nc 28358 (910) 674-4203 authorization to treat minor child when not accompanied by guardian robeson pediatrics must have permission from a child's legal guardian before providing medical care when someone other...
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Caregiver consent form for emergency treatment today a head of household often has to delegate the care of a loved one to a caregiver. most often this involves ensuring care for a child. at other times, however, it may involve an adult who cannot...
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