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Get IL YMCA Of Metro Chicago Participant Emergency Information Packet (Childcare) 2019-2024

/Guardian#1: Address: Employer: Relationship: Employer: o Mother Zip: Work phone: Relationship: Cell phone: City: Title: o Both Parents State: Work hours: Address: Cell phone: City: Title: Parent/Guardian#2: Child lives with: Age: State: Work hours: o Father Zip: Work phone: o Other ADULTS AUTHORIZED TO PICK-UP MY CHILD/EMERGENCY CONTACTS OTHER THAN PARENTS/GUARDIANS (Minimum of 2 are require.

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