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Cornerstone An Evangelical Free Church Rock Solid Medical Release Form In an effort to consolidate paperwork and to minimize confusion on events we are asking you to complete the form below. STUDENT S NAME BIRTHDATE ADDRESS HOME PHONE CITY STATE ZIP WORK PARENT NAME INSURANCE COMPANY GROUP NUMBER POLICY NUMBER DATE OF LAST TETANUS SHOT LIST MEDICATIONS AND DIRECTIONS FOR MEDICATIONS YOUR CHILD TAKES REGULARLY LIST ANY MAJOR ILLNESSES WITHIN THE PAST YEAR IF WE CANNOT CONTACT YOU IN CASE OF...
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