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Get HI Emergency Card 2017-2024

M q F q Birthdate Apt. No. Mailing Address Zip Code City Mother s/Legal Guardian s Name: Employer: Employer: Home Phone: Cellular Phone: Bus. Phone: Year Active Duty: Yes q No q Branch of Military Service: Home Phone: Cellular Phone: E-mail Address: Day Zip Code Child resides with Father s/Legal Guardian s Name: Active Duty: Yes q No q Branch of Military Service: Month Bus. Phone: E-mail Address: EMERGENCY CONTACTS: In case child listed above becomes ill or is in.

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