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RLC Student Ministries Permission Form
Medical Information - Emergency Medical Authorization
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* Indicates required question
Child's Name:
*
First and Last Name
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
School:
*
Your answer
Grade:
*
Choose
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Do you have another child to add?
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