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technodogs:forms:permission_slip

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technodogs:forms:permission_slip [2022/10/01 16:16] worthingtechnodogs:forms:permission_slip [2022/10/01 17:00] (current) – external edit 127.0.0.1
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                                                             Student Name                                                             Student Name
 to accompany their teammates on a trip to participate in to accompany their teammates on a trip to participate in
-**Bloomfield Girls Robotics Competition** located at **Bloomfield Hills High School** in the city of **Bloomfield Hills** on the dates of **Oct 14Oct 15** +(put namelocation, date of competition here) 
 and understand that they will be transported by a Private Vehicle. \\ \\ and understand that they will be transported by a Private Vehicle. \\ \\
 **Authorization and Release for a Passenger in a Vehicle ** \\ **Authorization and Release for a Passenger in a Vehicle ** \\
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              Parent or Legal Guardian Signature                                    Date              Parent or Legal Guardian Signature                                    Date
      
-**Emergency Information**  +**Emergency Information** \\ 
-    + 
-   ______________________________   ______________________________   ______________________________ +  ______________________________   ______________________________   ______________________________ 
-            Home Phone                        Cell Phone                       Work Phone+           Home Phone                        Cell Phone                       Work Phone
            
-   ________________________________________   _____________________________________________________ +  ________________________________________   _____________________________________________________ 
-         Name of Insurance Carrier                   Family Physician Name and Phone Number+        Name of Insurance Carrier                   Family Physician Name and Phone Number
  
 Medication that **must accompany the child** and information that you wish to share (ie. allerigies, medications, medical conditions, etc): Medication that **must accompany the child** and information that you wish to share (ie. allerigies, medications, medical conditions, etc):
-        +
    ______________________________________________________________________________________________________    ______________________________________________________________________________________________________
  
technodogs/forms/permission_slip.1664640970.txt.gz · Last modified: 2022/10/01 17:00 (external edit)

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