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Get emergency card for school 2022-2024

Le Initial) Sex: q M q F Birthdate Apt # Zip Code City Student Lives With Parent/Legal Guardian Name: Employer: Employer: Phone: E-mail Address: q Cell q Home q Work q Cell q Home q Work / Zip Code Parent/Legal Guardian Name: Active Duty: q Yes q No Branch: Phone: / Active Duty: q Yes q No Branch: Phone: Phone: E-mail: q Cell q Home q Work q Cell q Home q Work EMERGENCY CONTACTS: If student becomes ill or is injured at school and parent/legal guardian cannot be contacted, sc.

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