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I <br />'1 <br /> I <br /> I <br /> I <br /> I <br /> I <br /> <br /> HANDICAPPED CHILD AREA <br />WARNING SIGN REGISTRATION <br /> <br />(Please Print) <br /> <br />NmE <br /> '('~arent) <br /> <br />/ <br /> ('cH'i'i d) <br /> <br />ADDRESS <br /> <br />HOME PHONE WORK PHONE <br /> <br />Discription of Child's Handicap <br /> <br />Note- Upon request, the registrant shall provide the City with a medical <br /> confirmation of the Child's handicap. <br /> <br />~, the 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 />attention we:pay to our children when they are outside. <br /> <br />Signature Date <br /> <br />>ost-lt.TM brand fax transmi~l~l mem~ <br /> <br /> <br />