Special Concerns Response Information Logan's Law (HB 631)



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General Information About the Person With Special Concerns


















Responsible Party Completing This Form




Emergency 魅影直播 Information



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3rd 魅影直播


BY SUBMITTING THIS FORM, I AM SIGNING THIS FORM ELECTRONICALLY, AND I AGREE THAT MY ELECTRONIC SIGNATURE IS THE EQUIVALENT OF MY MANUAL SIGNATURE ON THIS FORM.

 

I understand it is my responsibility to resubmit this form annually to maintain my information on the Logan's List. Any changes required prior to the annual update, must be submitted by completing a new form. Please allow three (3) business days for this information to be updated in our system.