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Get Activities Consent Form - Indiana University Southeast - Ius

First Middle Last Date of Birth: Month Day Year Facility Name: Indiana University Southeast Children s Center Facility Address: 4201 Grant Line Road, New Albany, IN 47150 Consent is given for the items indicated below: Transportation Transportation by the program for walking trips to areas surrounding the facility. (e.g. children being transported by the way of tricycle, riding toy, wagon, etc.) Photo Permission Permission to ha.

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