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Legacy Preparatory Academy Ms. Yolonda Capers Principal 302 E. Linebaugh Avenue Tampa Florida 33612 Ph 813 253-0053 Fax 813 253-0182 www. Signature of parent/legal guardian Date NOTARIZATION STATE OF FLORIDA COUNTY OF HILLSBOROUGH SUBSCRIBED AND SWORN AFFIRMED TO BEFORE ME A NOTARY PUBLIC THIS My commission expires Notary Public. Legacyprepacademy. org MEDICAL RELEASE FORM Student s Name Parent//Legal Guardian s Name Phone s Home Work Cell Other STATEMENT OF CONSENT To be signed in the...
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