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COVID-19 PUBLIC HEALTH EMERGENCY SIGNATURE PAGE
For Parents & Guardians & Designated Others
Child's Name
*
Child's Birthdate
*
+
Parent's Name
*
I certify that I have read, understand, and agree to comply with the provisions listed herein,
Covid-19 Health Emergency Acknowledgement and Disclosure
, and in the
Covid-19 Policies and Procedures
document. I also certify that I have reviewed these documents with my spouse, and/or with anyone else who picks up or drops off my child/children, and that I am responsible for their compliance.
Signature of Parent/Guardian authorizing above
*
🛈
Date
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