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Get and Sign Dhr Cdc 1951 Adobe Form 2001-2022
Address:
Employer's telephone number:
List telephone numbers such as beeper, cellular
phone, etc.
Employer's telephone number:
Instructions regarding how parent/guardian may be
reached in an emergency:
Person(s) to be contacted in an emergency if parent(s)/guardian(s) cannot be reached:
Name
Relationship to Child
Name of Child’s Doctor
Address
Address
Telephone Number
Telephone number
Emergency Authorization:
I give permission for the child care facility to obtain emergency medical...
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