PERMISSION FOR EMERGENCY CARE

Diocese of Arlington
Appendix F-1

 

The Following FOrm must be completed
by Parent/Guardian

Permission for Emergency Care

To be completed and signed annually by a parent/guardian
Name(Required)
Nickname
Address(Required)
Student lives with (applicable custody paperwork must be submitted to school)(Required)
(e.g. diabetes, heart disease, contact lenses, hearing aids, etc.)

Saint Michael the Archangel Catholic High School

6301 Campus Dr, Fredericksburg, VA 22407

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