Person's Special Needs List
This list is carried by (name)_____________________________________________ a (race) _________________________________ male female born in (year) _____ who's address is _____________________________, ___________________________, _____________________________, ___________________________. Telephone (______) ______-________. Contact (name)_____________________________________________ who's address is _____________________________, ___________________________, _____________________________, ___________________________. Telephone (______) ______-________. or (name)_____________________________________________ who's address is _____________________________, ___________________________, _____________________________, ___________________________. Telephone (______) ______-________.
This person has the following medical or special needs: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
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