CAREFULLY BEFORE SIGNING BELOW. CCS Student’s Printed Name CCS Student’s Signature Date I hereby voluntarily give permission for the CCS Student to use SHS and agree to be bound by the terms of this Consent, Waiver, and Release Agreement. Legal Guardian’s Printed Name Legal Guardian’s Signature Date EMERGENCY CONTACT INFORMATION PRIMARY CONTACT Name: Relationship: Cell: ( ) Work phone: ( ) Home: ( ) _ SECONDARY CONTACT Name: Relationship:
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Samples: health.tcnj.edu, health.tcnj.edu, health.tcnj.edu
