Emergency Contact Profile 2015/2016 OLD

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    Primary Parent/Guardian Information

    The parent who is the head of household for the child/ren's primary residence, usually the father.
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    IL or two-letter uppercase state abbreviation
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    Please enter valid ZIP code
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    10-digit area code and number only, no symbols
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    10-digit area code and number only, no symbols
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    Please enter valid email address
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    10-digit area code and number only, no symbols
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    Please enter valid email address
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    Secondary Parent/Guardian

    Information for child/ren's other parent.
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    Two-letter uppercase state abbreviation
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    Please enter valid ZIP code
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    10-digit area code and number only, no symbols
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    10-digit area code and number only, no symbols
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    Please enter valid email address
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    10-digit area code and number only
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    Please enter valid email address
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