I understand in case of an emergency, that Verlyn Music may call 911.
Doctor contact number
Please list any medical and/or physical ailment your child has that we should know about.
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If your child has any allergies, please list them:
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Any child with food allergies must bring their own lunch and snacks daily.
In case of emergency please call:
Name direct contact #
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Name direct contact #
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Name direct contact #
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Sign:
Date:
