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Get Child Enrollment And Authorization Oregon Form

Back side of form Parent or Guardian Contact Information Name (first, last) Relationship Street Address City Home phone Cell phone Employer/Work Hours Work phone Name (first, last) Relationship Street Address City Home Phone Cell phone Employer and Work Hours Work phone Zip Zip Required Emergency Contact Information- person other than parent or guardian that is authorized to pick up child Name (first, last) Phone Relationship Name (first, last) Phone Relationship Non-Em.

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