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2023 PA Prey Counts Enrollment Form (This information is confidential to the PA Prey Counts program)Date Form Completed://MMDDYYLast Name (Child) First Name (Child) Middle InitialStreet Address CountyCityState Zip
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How to fill out name of parent or

01
Write the first name of the parent in the designated space on the form.
02
Write the last name of the parent in the next designated space on the form.

Who needs name of parent or?

01
Individuals who are filling out forms that require identification or verification of parentage may need to provide the name of a parent.

What is Name of Parent or Guardian completing this application Form?

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Name of parent or refers to the individual who acts as the primary caregiver or legal guardian of a minor child.
The name of parent or must be filled out by any individual who is legally responsible for the care and well-being of a minor child.
The name of parent or can be filled out by providing the full legal name and contact information of the individual acting as the primary caregiver or legal guardian of the minor child.
The purpose of name of parent or is to ensure that the proper authorities have a record of who is legally responsible for the care and well-being of a minor child.
The information that must be reported on name of parent or includes the full legal name, contact information, and relationship to the minor child of the individual acting as the primary caregiver or legal guardian.
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