Ingresos del Hogar / el Number of miembros en el Hogar - Household income / Number of Members in th

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Por este FAVOR rellene formulario y firme como padre o Guardian - Please complete and sign this form as a parent or guardian - Please (please tanprisouple) complete and sign this form as a parent or guardian (Guardian)
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Favor of identificar al amigo, Escuela, Iglesias, Organization o templo de VODU - Please Identify the friend, school, church, organization or voodoo temple - Please identify friends, schools, churches, organizations and onfo
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Leadership; Ciudad; Estado; Telephone de casa; Código code; origen étnico - Address; City; State; bbq concession trailers House telephone; Pin code; ethnic backgrounds - Address; city; state; home phone; area code; ethnic children
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Ingresos del Hogar / el Number of miembros en el Hogar - Household income / Number of Members in the household - How much do family / How many people who live in the house
El Niño vive con (es el mismo que Comprobar if arriba): Number: Primary number; Segundo number; Apellido; Leadership; Number del teléfono; Number of cellular - Child lives with (Check yew same as above): Name: First name: Middle name; Last name; Address; home phone ........
Historia Medica - Medical History - History of health care esta su bajo el cuidado de un HIJO medical ahora? - Is your child under the physician's care now? - Does your child have a doctor?
Su HIJO ha estado hospitalizado? - Has your child been hospitalized? - Does your child was hospitalized? Ha tenido su una operación HIJO significant? - Has your child's clothes major operation? - Does your child has had an operation?
Hay algo más que saber sobre deberíamos the su salud de HIJO? Díganos por FAVOR - Is there anything Else Should we know about the health of your child? Tell us please - Is there anything else we should know about your child's health? Tell us please.
Es su HIJO alérgico the algunos de los siguientes: Aspirina; Penicilina; Codeine; acrílico; metal; latex; anestesias locals? - Is your child allergic to Any of the following: Aspirin; Penicillin;
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