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TODAY S DATE FIRST NAME MIDDLE NAME/INITIAL CITY COUNTY STATE SSN D/L or STATE ID Signature Signature of Parent/Guardian if Subject is Under 18 LAST NAME HOME ADDRESS ZIP STATE ISSUED EMAIL ADDRESS required For identification purposes only please provide FULL DOB Protect My Ministry Inc. 14499 Dale Mabry Hwy Ste 201 South Tampa FL 33618 Phone 800-319-5581 Fax 800-319-5582 www. VI VII DISCIPLINE 1. Leaders may not spank hit grab shake or otherwise physically discipline anyone. Of injury or...
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Parents/guardians of any minor involved in any allegation of abuse shall be immediately notified.
The individuals responsible for the minor's well-being are required to file the report.
The form must be completed accurately and submitted promptly to the appropriate authorities.
The purpose is to ensure that any abuse allegations involving minors are addressed promptly and appropriately.
Details of the abuse allegations, names of parties involved, and any supporting evidence must be reported.
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