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 History Authorization 2014-2023

History Authorization 2014-2023

Use a gscnc form 2014 template to make your document workflow more streamlined.

Only Father Only Other: Address (if different than child’s): Phone 1: Phone 2: Phone 3: Parent/Guardian 2: E-mail: Address (if different than child’s): Phone 1: Phone 2: Phone 3: E-mail: EMERGENCY CONTACTS Name: Relationship: Phone 1: Phone 2: Phone 3: Name: Relationship: Phone 1: Phone 2: Phone 3: HEALTH INFORMATION (Check all that apply and provide requested information) Allergies Yes No Explain “yes” answers. Include the type of allergy (e.g.- “nut allergy” in the...
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