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00 per 30 minutes will be charged for children picked up after 5 31p.m. per school clock. PLEASE COMPLETE HEALTH FORM ON REVERSE SEE BACK HEALTH INFORMATION Name of Student Date of Birth Does the student have a known medical diagnosis now If yes please describe Has your child ever been hospitalized Yes No If Yes list dates and explain Date of last physical exam Doctor Telephone IN CASE OF AN EMERGEMCY YOUR CHILD WILL BE TAKEN TO The OU Medical Center CHILDREN S HOSPITAL 700 NE 13th Street...
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