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Health Form/Formulario de Ayuda
A Health Form is REQUIRED by the Diocese of Charlotte for EACH child who participates in Faith Formation classes. Please answer all questions before clicking submit.
Se requiere un formaulario para cada nino.
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* Indicates required question
Email
*
Your email
Child's last name/Apellido de la nina
*
Your answer
Child's first name/el primer nombre del nino
*
Your answer
Date of birth/feche de nacimiento
*
Your answer
Address/direccion
*
Your answer
phone/telefono
*
Your answer
parent-guardian name/nombre del padre de familia-guardian
*
Your answer
emergency contact name & phone/nombre y telefono del contacto de emergencia
*
Your answer
doctor name & phone/ nombre y telefono del medico
*
Your answer
Date of last medical exam/fecha del ultimo examen medico
*
Your answer
Medical Insurance name & policy number/nombre del seguro medico y numero de poliza
*
Your answer
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