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Fillable Online Michigan Family Home Daycare Licensing 2019-2023
Received Medical Treatment if applicable and known Phone Number of Treating Physician / Medical Facility / Hospital if applicable Any Handicaps Health Problems or Exceptions Listed on the Child s Health Records if applicable If Fire Describe Damage PERSON S NOTIFIED law enforcement fire marshal parent/legal guardian etc. Name of Person Notified Notification Date Signature of Person Completing This Report Title Date Signature of Licensee/Responsible Person LARA is an equal opportunity...Show details
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