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To the JCC staff to provide routine health care for this student and if the staff deem it advisable for the welfare of this child, I authorize them Name Parent/Guardian to obtain services of medical professionals and to provide necessary related transportation. I authorize any physician and any hospital, through its medical staff, Health History: If yes, please check, give approximate month/s and year/s, and, in to take appropriate measures. I understand that I am responsible for this child's o.

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