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I hereby agree to hold Propel Schools and its representatives harmless for exercising its judgment in authorizing such medical treatment. Name Relationship Address Phone No Physician s Name Office Phone Dentist s Name Office Phone List Known Medical Problems Allergies None List Allergies including medications Does your child need a prescription adrenalin auto injector Epi-Pen No Yes If yes describe Hospital Preference HEALTH SCREENING MEDICAL EMERGENCY AUTHORIZATION I give my permission for...
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