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Get North Technical High School Emergency Contact Form 2013-2024

______________ Insurance Plan__________________________ Membership Number ____________________ Expiration Date ________ Signature Required ________________________________________________ Date_________________________ (Parent or guardian) HEALTH INFORMATION FORM (To be complete by parent or guardian prior to entry into North Tech) Does pupil have a history of any of the following: Asthma; Diabetes; Heart Condition; Convulsive disorder Allergies (list) ____________________________________________.

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