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Signed medical release and list of any allergies and/or health conditions. Please note that Starfish staff are NOT AUTHORIZED TO ADMINISTER MEDICATION.
Medications now being taken:
Student is allergic to these medications, substances, and/or foods:
List any unusual health information:
The undersigned hereby acknowledge that participation in Starfish Learning Center and related activities may involve a small but inherent risk, and the undersigned hereby assume all such risk and does hereby release and forever discharge Starfish Learning Center, the staff, and all agents thereof from any and all liability of whatever kind or nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen, bodily and personal injuries, and the consequences thereof, resulting from the student’s participation in or involvement with this program. Please sign by typing your name and the date.
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