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DistrictCampus
CAMPUS

Permission Slip

Fill Form out as completely as possible.
Please Fill Out The Permission Slip Below




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STUDENT'S FULL LEGAL NAME AS ON BIRTH CERTIFICATE, ADOPTION PAPERS, ETC.:


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PERSON TO CONTACT IN CASE OF EMERGENCY:


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School Health History




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The Tylenol/Acetaminophen and Chewable antacid are on hand in the office for students with, headache, mild pain, or upset stomach. Please initial which of these you give permission for school personnel to administer to your child:


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*By typing your name above or below, You agree that this is valid as your signature.



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