Acknowledgement of Receipt of Copy. I acknowledge receiving g a copy of this Agreement and understand the terms and conditions under which the person who I have selected as a Private Service Provider may provide services to my child at a Xxxxx County Public School. Parent/Guardian/Educational Surrogate Requesting Services Signed Print Name
Appears in 4 contracts
Samples: Private Service Provider Access Agreement, Private Service Provider Access Agreement, Private Service Provider Access Agreement
Acknowledgement of Receipt of Copy. I acknowledge receiving g a copy of this Agreement and understand the terms and conditions under which the person who I have selected as a Private Service Provider may provide services to my child child, , at a Xxxxx Duval County Public School. Parent/Guardian/Educational Surrogate Requesting Services Signed Parent Signature Print Name
Appears in 3 contracts
Samples: Private Service Provider Access Agreement, Private Service Provider Access Agreement, Private Service Provider Access Agreement
Acknowledgement of Receipt of Copy. I acknowledge receiving g a copy of this Agreement and understand the terms and conditions under which the person who I have selected as a Private Service Provider may provide services to my child child, , at a Xxxxx County Public School. Parent/Guardian/Educational Surrogate Requesting Services Signed Parent Signature Print Name
Appears in 2 contracts
Samples: Private Service Provider Access Agreement, Private Service Provider Access Agreement
Acknowledgement of Receipt of Copy. I acknowledge receiving g a copy of this Agreement and understand the terms and conditions under which the person who I have selected as a Private Service Provider may provide services to my child at a Xxxxx County Public School. Parent/Guardian/Educational Surrogate Requesting Services Signed Parent Signature Print Name
Appears in 1 contract
Acknowledgement of Receipt of Copy. I acknowledge receiving g a copy of this Agreement and understand the terms and conditions under which the person who I have selected as a Private Service Provider may provide services to my child at a Xxxxx County Public School. Parent/Guardian/Educational Surrogate Requesting Services Signed Print Name
Appears in 1 contract