• EMERGENCY CONTACT/PARENTAL CONSENT FORM

  • 55 PA CODE CHAPTERS 3270.124(ab), 3270.181 & 182; 3280.124 (ab), 3280.181 & 182; 3290.124 (ab), 3290. 181 & 182

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  • EMERGENCY CONTACT PERSON(S):

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  • PERSON(S) TO WHOM CHILD MAY BE RELEASED:

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  • PARENTAL CONSENT IF REQUIRED FOR EACH ITEM BELOW. PLEASE INITIAL EACH ITEM.

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