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Family Preparedness Plan: Caregiver's Authorization Affidavit

Created by
Creado por
CHIRLA
Last updated
Última revisión
3/19/2022

Completion of items 1 - 4 and the signing of the affidavit is sufficient to authorize enrollment of a minor in school and authorize school-related medical care. Completion of items 5-8is additionally required to authorize any other medical care.