PDF-1. A parent/legal guardian who meets the requirements for home schoo

HS 3 07262016 HomeSchooled InCar Driver Education INFORMATION SHEET. 4 4 Parent or Legal Guardian Agreement: FByFmyFsignMPureFbeloR,FHFFerPifyFPhMPFMllFPheFinformMPionFprovidedFforFPhisFTournMmenPFPlMyerFVeri�FMPionFisFPrueFMndFForreFPFMndFprovidesFPheF nece Dress PARENT OR LEGAL GUARDIAN AND NOTARIZED, FOR ALL CARD APPLICANTS UNDER THE AGE OF EIGHTEEN (18) YEARS BEFORE A CARD WILL BE ISSUED 5. By the act of paying dues, member accepts all rules contai NO Teenager/Patient Information: Name: Date of Birth: Address: SSN/MRN: Email Address: Parent/Legal Guardian Information: Name: Date of Birth: Address: SSN/MRN: Ema (of any deceased parent reflected on the UBC or Equivalent Document) ID or Passport of parent(s) or legal guardian(s) Thus signed and **sworn/solemnly affirmed before me on this APPLICATION INFORMATION: PART A Please PRINT) Parent (legal guardian): _______________________________________________________________________ , ________ Last Name First Name MI Email Address: _______ Patient InformationSocial Security TDL Marital Status S M D W Sex M F Race EthnicityPrirent/Guardian Informationif patient is under Name LastFirstDOB//Spouse InformationInsurance In Israel Trip2020RulesPlease ensure thatyou carefully read the list of rules set out below and have both the participant and a parent/ guardian sign below accepting agreement 1Jewish Journey believes st Introduction7Overview8Prevention14Planning15IHP16IEP17Student1920Administration21Administrator21Nurse22MedicalDirector23Teachers24Personnel26Volunteers27Personnel28EnvironmentalConcerns29Accommodation Page 1 of 2 AFTER CARECONTRACTStudent Name Entering Grade Car Loop with Sibling Student should be taken to 200 pm car lpleasecheck oneSiblings Name enrolled at CCA Office Use Page 1 of 2 AFTER CARECONTRACTStudent Name Entering Grade Car Loop with Sibling Student should be taken to 200 pm car lpleasecheck oneSiblings Name enrolled at CCA Office Use June 714 20182018The Washington Youth Tour an awesome experienceWashington EMC invites local students to apply for the trip of a lifetime The cooperative will select two2 High School Juniors for an a Page 1 of 2 AFTER CARECONTRACTStudent Name Entering Grade Car Loop with Sibling Student should be taken to 200 pm car lSiblings Name enrolled at CCA Office Use Only Check On Parent/Legal Guardian CertificationPO Box 201430 Helena MT 596201430 Phone 406 444-3933 Fax 406 444-1631dojmtgov/drivingInstructions Parent/Legal Guardian - complete this form and submit it to th Parent (or guardian) and Child. I, currently residing at am aparent (or the guardian of the person) of the following child (or of a child likely to be born): Guardian. I hereby appoint the follo