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The staff of Above the Influence would like to make this program accessible and successful for each student involved. We request that you fill out this form, including any learning disabilities, medical conditions, or any medications being taken that you would like us to know about to make this program as beneficial and safe to your child as possible.
I hereby consent to my child’s participation in this program. Further, I consent to the release of information related to my child’s attendance and participation in this program to the referring program (if applicable).
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