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  1. GLYNN BRUNSWICK 911

    Special Concerns Response Information Form
    Logan's List (O.C.G.A 38-3-182)

  2. Form Type
  3. General Information for Special Concerns Person

    Please fill out the following fields with information specific to the Special Concerns Person

  4. Normal Routine Information

    Please list employer or school information specific to the Special Concens Person

  5. Medications and Special Response Information

    Please list Medication and Special information for Special Concerns Person

  6. This person is:
  7. Responsible Party Completing This Form

    Please fill out the following information specific to the Person Completing This Form.

  8. Emergency Contact Information

    Please list additional points of contact for Special Concerns Person.

  9. Leave This Blank:

  10. This field is not part of the form submission.