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Child's Name Grade Date
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Parent's/Guardian's Name: |
Parent's/Guardian's Name: |
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Address: |
Address: |
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Relationship to Student: |
Relationship to Student: |
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Cell Number: |
Cell Number: |
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Work Number: |
Work Number: |
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Email Address: |
Email Address: |
Emergency Contact & Allowed to Pick-Up My Child from School
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Name |
Relationship to Student |
Cell Number |
Home Number |
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1. |
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2. |
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3. |
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4. |
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5. |
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A preview of the form. ↓