EPIC Lock-In Parent/Guardian Waiver
Parent/Guardian's First Name *
Your answer
Parent/Guardian's Last Name *
Your answer
Name of Student(s): *
Your answer
Parent/Guardian Phone Number *
Your answer
If your child has any chronic medical conditions please list below.
Your answer
If your child takes any routine medications please list below.
Your answer
If applicable, please list the allergies of your student(s) below:
Your answer
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