Health History and Medical Release Form
For Parish events and activities in the 2019-20 School Year. Have your child(ren)'s health insurance, pediatrician, and emergency contact information accessible before completing this form.
Family Information
Last Name of Children *
Your answer
Parent/Guardian Last Name *
Your answer
Parent Guardian First Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Parent Cell Phone *
555-555-5555
Your answer
Home Phone
555-555-5555
Your answer
Parent Work Phone
555-555-5555
Your answer
Parent Email *
Your answer
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