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Does the child have contact with the other parent? Is anyone legally denied access to the child? Are there any custody orders in place? Any other information? OUT OF SCHOOL HOURS CARE 3 MEDICAL HEALTH INFORMATION Clinic s Name: Doctor's Name: Address: Phone: Have any of the children any physical limitations or medical conditions? (eg Asthma, Epilepsy, and the treatment required in an emergency). Child s Name Child s Name Child s Name Condition Condition Condition Are the childr.

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