ࡱ> ` Vbjbjss 4?)$,D$h(hf M 5!!H'''''''$)h+x5' "YM " "5'"(%%% " '% "'%%%\ Xj"%C&8(0h(%+"+%+%L " "% " " " " " " " "5'5'% " " "h( " " " "$$$D h$$$h$$$ East Baton Rouge Parish School System Student Registration and Data Verification Form SCHOOL OFFICE COPY: SCHOOLYEAR  FORMTEXT       SCHOOL USE ONLY: Student ID Number  FORMTEXT       Grade  FORMTEXT       Entry Date  FORMTEXT       Teacher Name  FORMTEXT       Teacher #  FORMTEXT       School Number  FORMTEXT       School Use  FORMTEXT       Parents: This is your child s registration form. Please complete all blank items in each section on ALL PAGES. STUDENT INFORMATION Student s LEGAL Last Name  FORMTEXT       First Name  FORMTEXT       Student s Address  FORMTEXT       Apt.  FORMTEXT       Zip Code  FORMTEXT       Birth Certificate Number  FORMTEXT       Ethnicity:  FORMCHECKBOX Male  FORMCHECKBOX  Am. Ind./Alaskan Native Has the student ever attended a school in Louisiana?  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX Female  FORMCHECKBOX  Asian/Pacific Islander Has the student ever attended a school in EBRPSS?  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Black (not of Hispanic Origin) Last school attended?  FORMTEXT       if school is not in EBRPSS  FORMCHECKBOX  Hispanic Street  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT        FORMCHECKBOX  White (Not of Hispanic Origin) Is this student the subject of a court or custody order? ?  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Other If yes, please provide a copy of the order to the school. Language spoken at home  FORMTEXT       Language first acquired by student  FORMTEXT       Language most often spoken by student  FORMTEXT       Has this student ever received services as an Exceptional Student?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, Please indicate the student s exceptionality:  FORMCHECKBOX Gifted  FORMCHECKBOX  Talented  FORMCHECKBOX  Other Brothers/Sisters in an EBR School this yearDate of Birth (Mo/Day/Yr.)SchoolGrade FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       PARENT/GUARDIAN Relation  FORMTEXT       Does the student reside at this address?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Last Name  FORMTEXT       First Name  FORMTEXT       Home Phone  FORMTEXT       Address  FORMTEXT       Apt. # FORMTEXT       Zip  FORMTEXT       Cell Phone  FORMTEXT       Other Phone  FORMTEXT       Place of Employment  FORMTEXT       Work Phone FORMTEXT       Relation  FORMTEXT       Does the student reside at this address?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Last Name  FORMTEXT       First Name  FORMTEXT       Home Phone  FORMTEXT       Address  FORMTEXT       Apt. # FORMTEXT       Zip  FORMTEXT       Cell Phone  FORMTEXT       Other Phone  FORMTEXT       Place of Employment  FORMTEXT       Work Phone FORMTEXT       Person with whom the student lives if not the parent/guardian: Last Name  FORMTEXT       First Name  FORMTEXT       Home Phone  FORMTEXT       Address  FORMTEXT       Apt. # FORMTEXT       Zip  FORMTEXT       Cell Phone  FORMTEXT       Other Phone  FORMTEXT       Place of Employment  FORMTEXT       Work Phone FORMTEXT        GENERAL STUDENT INFORMATION Person Authorized to Pick up Your Child  FORMTEXT       Home Phone  FORMTEXT       Other Phone  FORMTEXT       Person Authorized to Pick up Your Child  FORMTEXT       Home Phone  FORMTEXT       Other Phone  FORMTEXT       Emergency Contact  FORMTEXT       Home Phone  FORMTEXT       Other Phone  FORMTEXT       Emergency Contact  FORMTEXT       Home Phone  FORMTEXT       Other Phone  FORMTEXT       After school, how does the student get home or to after school care:  FORMTEXT       Student s Doctor/Clinic  FORMTEXT       Doctor s Phone  FORMTEXT       Clinic s Phone  FORMTEXT       Hospital of Choice  FORMTEXT       Special medical conditions/allergies/procedures of which the school should be aware  FORMTEXT        ALL OF THE ABOVE INFORMATION IS CORRECT PARENT/GUARDIAN SIGNATURE ___________________________________DATE____________ HEALTH SERVICE OFFICE COPY: SCHOOL YEAR  FORMTEXT       Student s LEGAL Last Name  FORMTEXT       First Name  FORMTEXT       Middle Name  FORMTEXT       DOB  FORMTEXT       Student s Address  FORMTEXT       Apt.  FORMTEXT       Zip Code  FORMTEXT       SSN  FORMTEXT       Contact Person Relationship  FORMTEXT       Does the student reside at this address?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Last Name  FORMTEXT       First Name  FORMTEXT      L0 2 F H J T V X Z z | }og\M\;M#jthxf hxf CJUaJjhxf hxf CJUaJhxf hxf CJaJh0FCJaJhxf h0F5>*CJaJh hxf CJaJh hAWCJaJjhOH5CJUaJ&jhxf h&95CJUaJhxf h 5CJaJ jhxf h 5CJUaJhxf hAW5CJaJhxf h0Fhxf 5h0FhhL5 h0F5h0FhAW5LZ | Fv{r{{ppp`gdxf gdAWekd$$Ifl*+ t0644 la $Ifgd0F`gd0F$a$gdxf V   & ( < > @ J L r t   ( * , 6 8 B P j l ԰ԞԌԄrԄ#jhxf hxf CJUaJh]CJaJ#jDhxf hxf CJUaJ#jhxf hxf CJUaJ#j\hxf hxf CJUaJ#jhxf hxf CJUaJhxf hxf CJaJjhxf hxf CJUaJ"jhOHCJUaJmHnHu, v | " 6 8 : D F n p ŲsasssOsss#jXh h CJUaJ#jh h&9CJUaJjh h CJUaJhxf h 56CJaJh h CJaJhxf h 5CJaJh,=h CJaJ%jhxf 5CJUaJmHnHu hxf hxf "jhOHCJUaJmHnHujhxf hxf CJUaJ#j,hxf hxf CJUaJ FH\^`jlnp̠qi^O^jh]h CJUaJh]h CJaJh]CJaJ#j(h h CJUaJ#jh h&9CJUaJh h&9CJaJjh h&9CJUaJ#j@h h&9CJUaJh h CJaJ"jhOHCJUaJmHnHujh h CJUaJ#jh h&9CJUaJ "$   &'(/0>?@ӯӝӋyg#jT h]hOHCJUaJ#jh]hOHCJUaJ#jlh]hOHCJUaJ#jh]hOHCJUaJ#jh]hOHCJUaJ#jh]hOHCJUaJh]h CJaJjh]h CJUaJ#jh]hOHCJUaJ#  DFJLhjlӯޚޏrӏj[Ph]h]CJaJjh]h]CJUaJh]CJaJ#j$ h]hOHCJUaJh]h&9CJaJh]hhLCJaJ(jh]hOHCJUaJmHnHu#j h]h&9CJUaJ#j< h]hOHCJUaJh]h CJaJjh]h CJUaJ#j h]hOHCJUaJ,.0:<JNPdfhrtz|޾޳޾޳޾޳}rcrQc#jh h]hOHCJUaJjh]h CJUaJh]h CJaJ#j h]h]CJUaJ#j h]h]CJUaJ#j h]h]CJUaJh]h]CJaJh]hhLCJaJ(jh]h]CJUaJmHnHujh]h]CJUaJ#j h]h]CJUaJXZvxzdf,.|gU#jh]hhLCJUaJ(jh]hOHCJUaJmHnHu#j8h]hhLCJUaJh]CJaJ#jh]hOHCJUaJjh]h CJUaJ#jPh]hOHCJUaJ#j h]hOHCJUaJjh]hhLCJUaJh]hhLCJaJh]h CJaJ!f>*`nz $$Ifa$gdhL`gdhL .0:<JLhjlz|"$@BожxpaVD#j|hOHhOHCJUaJh hhLCJaJjh hhLCJUaJhhLCJaJ#jhOHhOHCJUaJ#jhOHhOHCJUaJhhLhhLCJaJjhhLhhLCJUaJhhLCJaJ#j h]hhLCJUaJh]hhLCJaJ(jh]hOHCJUaJmHnHujh]hhLCJUaJBDZ\xz||~ݱݟÁygU#jKh hhLCJUaJ#jh&9h&9CJUaJh&9CJaJjh&9CJUaJ"jhOHCJUaJmHnHu#jch hhLCJUaJ#jdhOHhOHCJUaJhhLCJaJ#jhOHhOHCJUaJh hhLCJaJhhLCJaJjh hhLCJUaJ!z|^UUUU $IfgdhLkd$$Ifl\HD%(T  t0644 la   468BDFH\^`jlnp𹪟ygU#jh hhLCJUaJ#j2h&9h&9CJUaJh&9CJaJjh&9CJUaJ#jh hhLCJUaJh hhLCJaJjh hhLCJUaJhhLCJaJ"jhOHCJUaJmHnHu#jh h&9CJUaJh h&9CJaJjh h&9CJUaJFn^UUUU $IfgdhLkd3$$Ifl\HD%(T  t0644 la &(*468:Nĵ̵Čřĵ`̵Uh h&9CJaJ#jh hhLCJUaJ#jh&9h&9CJUaJh&9CJaJjh&9CJUaJ#jh hhLCJUaJh hhLCJaJjh hhLCJUaJhhLCJaJ"jhOHCJUaJmHnHujh h&9CJUaJ#jh h&9CJUaJ8`^UUUU $IfgdhLkd$$Ifl\HD%(T  t0644 laNPR\^bdf$&BDFTVrį|j|U||C||#jh]hOHCJUaJ(jh]hOHCJUaJmHnHu#jxh]h&9CJUaJjh]h&9CJUaJh]h&9CJaJh]h&956CJaJhxf 56CJaJ(jhxf 56CJUaJmHnHuhhLCJaJ"jhOHCJUaJmHnHujh h&9CJUaJ#juh h&9CJUaJ`bfN"$ ""$\WWWWWWWWWgd&9kd$$IflF\HD%(T  t0644 la rtv~&(<>@JLNdfz|~Ӷޡӏޡ}ޡkޡ#j0h]h&9CJUaJ#jh]h&9CJUaJ#jHh]h&9CJUaJ(jh]hOHCJUaJmHnHu#jh]h&9CJUaJh]hhLCJaJh]h&9CJaJjh]h&9CJUaJ#j`h]hOHCJUaJ$ 468BDdfz|~޾޾޾޾޾nɋ޾\޾޾#jth]h&9CJUaJ#jh]h,=CJUaJh]h,=CJaJjh]h,=CJUaJ#jh]h&9CJUaJ#jh]h&9CJUaJh]h&9CJaJ(jh]hOHCJUaJmHnHujh]h&9CJUaJ#jh]h&9CJUaJ# 8:NPR\^ , . B D F P R t v ޾޾޾޾޾޾޾޾v޾޾d޾޾#j,"h]h&9CJUaJ#j!h]h&9CJUaJ#jD!h]hOHCJUaJ#j h]hOHCJUaJ#j\ h]h&9CJUaJh]h&9CJaJ(jh]hOHCJUaJmHnHujh]h&9CJUaJ#jh]h&9CJUaJ& !!!! !0!2!F!H!J!T!V!p!r!!!!!!!!!!!!!!!"޾޾޾޾޾޾޾޾v޾g\h]h,=CJaJjh]h,=CJUaJ#jp$h]h&9CJUaJ#j#h]h&9CJUaJ#j#h]h&9CJUaJ#j#h]h&9CJUaJh]h&9CJaJ(jh]hOHCJUaJmHnHujh]h&9CJUaJ#j"h]h&9CJUaJ#"""" "L"N"b"d"f"p"r""""""""N#P#d#f#h#r#t###########޾ɯɯyɯgɯ#j&h]h&9CJUaJ#j@&h]h&9CJUaJ#j%h]h&9CJUaJ#jX%h]h&9CJUaJjh]h&9CJUaJh]h&9CJaJ(jh]hOHCJUaJmHnHujh]h,=CJUaJ#j$h]h,=CJUaJ####$$$$2$4$6$@$B$R$T$h$j$l$v$x$$$$$$$$$$$$$$$$$% %޾޾޾޾޾޾޾}޾k޾\jh]h]CJUaJ#j(h]h&9CJUaJh]h,=CJaJ#j(h]h&9CJUaJ#j(h]h&9CJUaJ#j'h]h&9CJUaJh]h&9CJaJ(jh]hOHCJUaJmHnHujh]h&9CJUaJ#j('h]h&9CJUaJ$ %4%6%8%B%D%p%r%%%%%%%%%%%%%%%%&j&l&&ԿԴ~l~WIh]h&956CJaJ(jh]hxf CJUaJmHnHu#jT*h]h&9CJUaJ(jh]hOHCJUaJmHnHu#j)h]h&9CJUaJjh]h&9CJUaJh]h&9CJaJ(jh]h]CJUaJmHnHujh]h]CJUaJ#jl)h]h]CJUaJh]h]CJaJ$F%%'$(()*++,,---.>0@0xyy$|b}d}P~Hgd,=gd&9&&&&&&&&&&&&&& '''''p'r'''''''''''''''((( ("(޾޾޾޾޾޾޾޾v޾޾d#j -h]h&9CJUaJ#j,h]h&9CJUaJ#j$,h]h&9CJUaJ#j+h]h&9CJUaJ#j<+h]h&9CJUaJh]h&9CJaJ(jh]hOHCJUaJmHnHujh]h&9CJUaJ#j*h]h&9CJUaJ'"(J(L(`(b(d(n(p((((((((((((((($)&):)<)>)H)J)f)h)|)~))))))))we#j/h]h&9CJUaJ#jP/h]h&9CJUaJ#j.h]h&9CJUaJ#jh.h]h&9CJUaJ#j-h]h&9CJUaJ(jh]hOHCJUaJmHnHu#j-h]h&9CJUaJjh]h&9CJUaJh]h&9CJaJ'))))**d*f*z*|*~**********++$+&+(+2+4+\+^+r+t+v++++++++++~,,гСЏ}k#j2h]h&9CJUaJ#j1h]h&9CJUaJ#j 1h]h&9CJUaJ#j0h]h&9CJUaJ#j80h]h&9CJUaJh]h]CJaJh]h&9CJaJ(jh]hOHCJUaJmHnHujh]h&9CJUaJ*,,,,,,,,,:-Z-------- . ..Կ~p^pI^)j2hxf h,=56CJUaJ#jhxf h,=56CJUaJhxf h,=56CJaJh,=5CJaJh]5CJaJh&95CJaJh&9h&95CJaJh&9CJaJ"jhxf CJUaJmHnHu(jh]hOHCJUaJmHnHujh]h&9CJUaJ#j|2h]h&9CJUaJh]h&9CJaJ....R.T.h.j.l.v.x.............////*/,/./8/{sasO#j4h h,=CJUaJ#jL4h h,=CJUaJh,=CJaJ#j3h h,=CJUaJ"jhOHCJUaJmHnHu#jd3h h,=CJUaJjh h,=CJUaJh h,=CJaJhxf h,=56CJaJ#jhxf h,=56CJUaJ(jhOH56CJUaJmHnHu8/:/b/d/x/z/|////////////////000000,0.000:0<0>0@0b0000xlh,=h,=5CJaJh0Fhxf CJ aJ #j6h h,=CJUaJ#j6h h,=CJUaJh,=CJaJ#j5h h,=CJUaJ"jhOHCJUaJmHnHu#j45h h,=CJUaJh h,=CJaJjh h,=CJUaJ&00000 1"1>1@1B1P1R1n1p1r1z111111111111112x"x$x8xĵ{i{WU{U#j8h h,=CJUaJ#j`8h h,=CJUaJh h,=CJaJ#j7hOHhOHCJUaJ#jx7hOHhOHCJUaJhhLh,=CJaJjhhLh,=CJUaJh,=CJaJ"jhOHCJUaJmHnHujh h,=CJUaJ#j7h h,=CJUaJ! Home Phone  FORMTEXT       Work Phone  FORMTEXT       Address  FORMTEXT       Apt. # FORMTEXT       Zip  FORMTEXT       Cell Phone  FORMTEXT       Other Phone  FORMTEXT       Contact Person Relationship  FORMTEXT       Does the student reside at this address?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Last Name  FORMTEXT       First Name  FORMTEXT       Home Phone  FORMTEXT       Work Phone  FORMTEXT       Address  FORMTEXT       Apt. # FORMTEXT       Zip  FORMTEXT       Cell Phone  FORMTEXT       Other Phone  FORMTEXT       Other Emergency Contact  FORMTEXT       Home Phone  FORMTEXT       Work Phone  FORMTEXT       Student s Doctor/Clinic  FORMTEXT       Doctor s Phone  FORMTEXT       Clinic s Phone  FORMTEXT       Special medical conditions/allergies/procedures of which the school should be aware  FORMTEXT       Medicines taken regularly at Home  FORMTEXT       Medicines taken regularly at School  FORMTEXT       Does the student have (check one) Private Insurance  FORMCHECKBOX  Yes  FORMCHECKBOX  No Medicaid  FORMCHECKBOX  Yes  FORMCHECKBOX  No LACHIP  FORMCHECKBOX  Yes  FORMCHECKBOX  No Parent/guardian request insurance information  FORMCHECKBOX  Yes  FORMCHECKBOX  No ALL OF THE ABOVE INFORMATION IS CORRECT PARENT/GUARDIAN SIGNATURE ___________________________________DATE____________  ELECTRONIC COMMUNICATION SYSTEM: I hereby understand that students of the East Baton Rouge Parish School System will be granted access to the system s electronic communications system which includes access to the Internet and Worldwide Web. This access is a privilege, not a right. The system may suspend or revoke a system user s access upon violation of system policy and/or administrative regulations regarding acceptable use or upon written parental request to the campus principal. I have read the East Baton Rouge Parish School System electronic communications system policy and administrative regulation. These are provided at the time of registration as well as being available at each school. The information also may be found on the East Baton Rouge Parish School System website http://www.ebrschools.org. I further understand that the East Baton Rouge Parish School System will not publish my child s individual photograph, video, and/or last name without my written permission. PARENT/GUARDIAN SIGNATURE ______________________________________ DATE ________________  PARENT E-MAIL ADDRESS (OPTIONAL): The system would like to communicate with you via e-mail should you wish. Provision of an e-mail address is not required. If you do not provide an address, the system will continue to communicate with you in its regular manner to assure continued provision of vital and important information. My e-mail address is  FORMTEXT       PARENT/GUARDIAN SIGNATURE ______________________________________ DATE ________________ DIRECTORY INFORMATION: The East Baton Rouge Parish School System regularly receives requests for directory information on students enrolled in the System. Director information includes, but is not limited to, information such as student name, address, telephone number, date and place of birth, photographs, participation in sports, grade level, dates of attendance, enrollment status and e-mail address.  FORMCHECKBOX  I GIVE  FORMCHECKBOX  I DON T GIVE permission to release student directory information. PARENT/GUARDIAN SIGNATURE ______________________________________ DATE ________________  STUDENT HEALTH SERVICES: I understand that Health Care Centers in Schools/EBRPSS School Health Team ( Health Team ) will provide school health services in cooperation with EBRPSS staff as outlined in the attached summary, and give permission for the Health Team, or any EBRPSS employee or any other staff under the guidance of the Health Team, to provide the described services to the student as he/she may require while present in school. I understand that, if the student has a serious injury or illness, I will be contacted and the physician/clinic shown on the reverse side of this form and/or Emergency Medical Services (EMS) may be contacted if necessary. I understand and agree that neither Health Care Centers in Schools nor EBRPSS nor their staff will be responsible for any cost involved if the student needs emergency medical care. I understand and agree that in order to provide a coordinated system of care, the Health Team may exchange health care information about the student with the student s physician or other health care providers, upon approval by me. I understand and agree that the Health Team may share the student s health care information with EBRPSS personnel, in accordance with protocol, in order to provide appropriate attention to the Student s health needs. PARENT/GUARDIAN SIGNATURE ______________________________________ DATE ________________ 8x:x{H{J{l{n{{{{{{{{{{{{{{{||| |"|:|<|P|R|T|^|`|p|r|||ԺԺԺԺrԺ`#j@h h,=CJUaJ#j?h h,=CJUaJ#j,?h h,=CJUaJ#j>h h,=CJUaJ#jD>h h,=CJUaJh,=CJaJ"jhOHCJUaJmHnHujh h,=CJUaJ#j=h h,=CJUaJh h,=CJaJ%||||||||||||| } }}}}:}<}P}R}T}^}`}b}d}}}}}}}}}}}}}~~˹˧˕֊xf#jXBh h,=CJUaJ#jAh h,=CJUaJh0Fh,=CJ aJ #jpAh h,=CJUaJ#j@h h,=CJUaJ#j@h h,=CJUaJh h,=CJaJh,=CJaJ"jhOHCJUaJmHnHujh h,=CJUaJ(~(~*~>~@~B~L~N~~~~~~~~~~~~~~~ "68:DF `bvިޖބr#jDh h,=CJUaJ#j(Dh h,=CJUaJ#jCh h,=CJUaJ#j@Ch h,=CJUaJ"jhOHCJUaJmHnHu#jBh h,=CJUaJh h,=CJaJjh h,=CJUaJh,=CJaJ&vxzҀԀVbfh޹Ĝ|q_|q|qM|q#jlFhOHhOHCJUaJ#jEhOHhOHCJUaJhhLh,=CJaJjhhLh,=CJUaJh,=5CJaJh]CJaJh,=h,=CJaJ#jEh h,=CJUaJh h,=CJaJh,=CJaJ"jhOHCJUaJmHnHujh h,=CJUaJ#jEh h,=CJUaJށ,.08RTprt"$@BDRTprt|~޺ިޖބrghxf h,=CJaJ#j$IhOHhOHCJUaJ#jHhOHhOHCJUaJ#j N _ k q   # / 5 F R X o {   * 6 < N Z ` r ~   # : F L \ h n ".4=IO]ioIU[jv|$9EKZflFRXsS_e =IO`lr+1`lr %17IU[htz)5;m}$1=CLX^lx~(4:Uag} DPV}+=MUe !!## #0#?)FFFFFFFFFFFFFFG$G$G$G$G$G$G$G$G$FG$FFFFG$G$G$G$FFFG$G$G$G$G$FFFFFFFFFFFFFG$G$FFFFFFFFFFFG$G$FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFG$G$FFFFFFFFFFG$G$FFFFFFFFFFFFFFFFFFG$G$G$G$G$G$G$G$FG$G$8  @B (  NB  S D8cNB  S D8cNB  S D8cNB  S D8cNB  S D8cNB   S D8cNB   S D8cNB   S D8cB S  ? gL#?)L|)tL|)tLY|)YtL|)t0*t 0*t 0*t ?0*?tText1Text2Text3Text4Text5Check1Check3Check8Check9Check2Check4Check5Text6Check6Check7Text7Check10ml0:#A) | (@J#A)A) $ r}FR!'!3#4###i'n'()A)33333333333333333&9LZmm#6  ! # 6 7 J K ^ _ r t !=P`s2`s%8I\h{)<%1DL_l(;Uh}  DW}(>)A)A)  xf 2'&9OH;d],=AWhL0F} " # 7 K _ s t A)@ :u     ?) @ "&(*,.0xUnknownGz Times New Roman5Symbol3& z Arial"hff'#J'#J!@24d*)*)2QHX)?2%East Baton Rouge Parish School System  Oh+'0( 4@ ` l x (East Baton Rouge Parish School System  EBRPSS Registration Form 060109 2Microsoft Office Word@G@@zj@zj'#՜.+,0 hp  EBRPSSJ*) &East Baton Rouge Parish School System Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FAfjData ]J1Table+WordDocument4SummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q