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REQUEST FOR ADMINISTRATION OF MEDICATION AT FOOTHILL HORIZONS SUMMER CAMP Foothill Horizons FAX: (209) 5320019; TEL: (209) 5326673 Camper: Birth Date: Week(s) attending in 2016 (circle) 1 2 3 4 Male

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The purpose of SC 16 req is to gather relevant information for decision-making or investigation purposes.

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SC 16 req may require information such as transaction details, parties involved, dates, and any supporting documents.

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