Diagnostic Imaging Career Highlight Spaces available: 20 April 10, 2010 from 9:00 A.M. to 12:00 P.M.
Location: Providence St. Vincent Medical Ctr. 9205 SW Barnes Rd., Portland, OR 97225 Diagnostic Imaging Department
Full This event is available to: Grades 7-12
Online registration requires immediate printing capability Confirmation will be sent to your school within two days of registration end date.
Please fill out the following form:
First Name *REQ Last Name *REQ School Name *REQ E-mail *REQ Student Address *REQ Address (cont.) City *REQ State *REQ Zip *REQ Student Phone *REQ Emergency Contact *REQ Emergency Phone *REQ School Contact *REQ School Contact's Phone/E-mail *REQ Student ID Grade: *REQ Gender: M/F *REQ y/n *REQ IMPORTANT: I have completely filled out this form, printed it and will bring it with me to the event. I understand I will not be allowed to attend the event unless accompanied by this form with written parental/guardian signature. If you are lost call 503-216-1234. Student: By signing below you are acknowledging that you have read, understand and agree to comply with the Providence Behavior Standards and Dress Code. Student Signature_____________________________________ Parent: By signing below you are confirming that the student's immunizations are current, including: Measles, Mumps, Rubella and Varicella (Chicken Pox - by disease or vaccine). Other suggested immunizations include: Hepatitis B, Influenza and Tetanus. Parent Signature______________________________________
y/n *REQ IMPORTANT: I have completely filled out this form, printed it and will bring it with me to the event. I understand I will not be allowed to attend the event unless accompanied by this form with written parental/guardian signature. If you are lost call 503-216-1234.
Student: By signing below you are acknowledging that you have read, understand and agree to comply with the Providence Behavior Standards and Dress Code. Student Signature_____________________________________
Parent: By signing below you are confirming that the student's immunizations are current, including: Measles, Mumps, Rubella and Varicella (Chicken Pox - by disease or vaccine). Other suggested immunizations include: Hepatitis B, Influenza and Tetanus. Parent Signature______________________________________
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