hoot number, street oporfmeof number) • STATE ZIP CODE ilfr& Alin A:9mA H 3.50-ac CITY STATE DP CODE • T rzow ile"SHIP (40) AUTHORIZED FOR IMENENCY PICKUP U! .1ES • NO TELEPHONE RELATONSHIP (42) AUTHORIZED FOR EMERGENCY PICKUP 0 YES • NO (43) If school personnel are unable to contact you