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Tahanto Student Health Screening Form
A parent/guardian is required to fill out this form for their children at Tahanto. You will have the option of entering in more than one child's information.
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* Indicates required question
Email
*
Your email
Mother/Guardian 1: First Name
*
Your answer
Mother/Guardian 1: Last Name
*
Your answer
Mother/Guardian 1: Home Phone Number (type n/a if not applicable)
*
Your answer
Mother/Guardian 1: Work Phone Number (type n/a if not applicable)
*
Your answer
Mother/Guardian 1: Cell Phone Number (type n/a if not applicable)
*
Your answer
Mother/Guardian 1: Email address (type n/a if not applicable)
*
Your answer
Father/Guardian 2: First Name
*
Your answer
Father/Guardian 2: Last Name
*
Your answer
Father/Guardian 2: Home Phone Number (type n/a if not applicable)
*
Your answer
Father/Guardian 2: Work Phone Number (type n/a if not applicable)
*
Your answer
Father/Guardian 2: Cell Phone Number (type n/a if not applicable)
*
Your answer
Father/Guardian 2: Email address (type n/a if not applicable)
*
Your answer
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