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AREA <br /> <br />AgDRESS <br /> <br />/ <br /> (child) <br /> <br />HOHE ?HO~E <br /> <br />PHONE <br /> <br />Piscription of Child's H~ndicap_ <br /> <br />Note: <br /> <br />Upon request, the registrant shall provide the City· with ~ medical <br />confirmation of the Child's handicap. <br /> <br />Z, tEe.undersigned parent or legal guardian of the above named handicapped <br />child, do understand that the subject signs may not provide an increased <br />level of protection or safety; and that we must not reduce the level of <br />att'ent'ion we pay to our children when they are outside. <br /> <br /> I <br />I <br />I <br /> <br />Signature Da te 'l <br /> <br /> <br />