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1. PLEASE TYPE OR PRINT LEGIBLY 2. Parent or Guardian is to complete page I of Form A and the Disclosure and Consent Document. Please note student and parent are to sign both forms. 3. Physician/Provider is to complete and sign the physical examination on page 2. 4. Entire completed form is to be returned to school administration. SUBMITTING THIS FORM. I - School personnel should review form to assure it is completed properly. 2. ORIGINAL copy is to be retained in school files,. A health exami.

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