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2024 OA Kids Medical Release Form
O’Fallon Assembly
1400 N. Green Mount Rd, O’Fallon IL 62269
618-632-5584
churchoffice@ofallonassembly.com
This will be kept on file for the calendar year and you will need to update it if there are any changes that need to be made.
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Parent/Legal Guardian First & Last Name
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Cell Number
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Address (street, city, state, and zip)
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