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__________________________________________________________. 3. My name (adult giving authorization):___________________________________________. 4. My home address: _________________________________________________________. 5. ( ) I am a grandparent, aunt, uncle or other qualified relative of the minor. (See bottom of this form for a definition of qualified relative.) 6. Check one or both (for example, if one parent was advised and the other cannot be located): ( ) I have advised the parent(s)...

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