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Medical Record and Communication Release (Permission is optional) Please print Student: DOB: I, (parent/guardian), hereby grant permission for the nursing staff at Burlington County Special Services

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Burlington County Special Services is an organization that provides a range of services to individuals with disabilities in Burlington County, New Jersey.

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Parents or legal guardians of individuals with disabilities are required to file for Burlington County Special Services.

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Information such as the individual's disability diagnosis, educational and medical history, and needs for special accommodations must be reported on Burlington County Special Services.

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