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naturalizechild Health Information This information is for use by the work clinic to help care for your child until you can be reached if he/she becomes ill or injured, or if you cannot be reached by squall. Student Name (legal) _____________________________________________________________________________________________________________________________________________________________________________________ Last First Middle turn on I male I female Last school accompanied Birthdate ________________________________________________________________________________________________________ punctuate _______________________________________ State _____________________________________________________________________________________________________________________________________________________________________________________ Name of school urban center Has this student attended CISD school previously?

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