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315

Appendix I - Medical Information Form 315-1

Procedures

Medical Information Form

 

 

Does your child have any medical problems of which the school should be aware?

 

YES _______                                     NO ________

 

If yes, please list medical problem(s):

 

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

 

 

Student Name: ________________________________________________________________

 

Parent(s) Name: ______________________________________________________________

 

Signatures of Parent(s)

 

Per: ____________________________________________

 

Per: ____________________________________________

 

 

Date at _______________________________ this _________ day of ____________, 2_____.

 

 

 

 

 

Administrative Procedure 315 - Form 315-1

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October 2009