2019-20 HUMC Preschool Authorization For Emergency Treatment and Student Information
Each block must be completed. "N/A" or "SAME" may be used where applicable. You will not be able to move forward in the form if you have not completed a required question.
HUMC Preschool
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Name to be used at school (if different from 1st name): *
Your answer
Gender: *
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