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Get and Sign PART I Illness and Injuries Check All that Apply 2017-2022 Form
Immunization record Year Primary Series Completed Year of Last Booster DTaP / DTP / DT please circle Tdap MCV Meningococcal IPV Polio MMR Hepatitis B Varicella Chicken Pox Part V Sunscreen and Insect Repellent As a parent/guardian I accept responsibility for teaching my daughter how to apply sunscreen and insect repellent and will make sure my daughter is appropriately dressed for outdoor activities. Contact a parent/guardian or emergency contact. If no contact can be made I hereby give...
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