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HANDiC,~p£O cHILD AREA <br />WA~IIIG SIG~ REGISTRATIO~t <br /> <br />(please print) <br /> <br />ADDRESS---~- <br />HOME PHONE; <br /> <br />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 />I, the.undersigned p~rent or legal guardian of the above named handicapped <br />child, do understand that the subject signs may not provide an increased <br /> ~ of <br />level of p~otection or safety; and that we must not reduce the level <br />atten£ion ~e pay to our children when they are outside. <br /> <br /> Date <br />Signature <br /> <br /> <br />