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I hereby give permission for any first responder agency (including but not limited to: Police, Fire, Rescue, EMS, 911 Dispatch Center, Search & Rescue Personel) to retain and distribute the information contained in this registration form to other first responder personnel for the sole purpose of identification and protection of the person identified above in an emergency or crisis situation.
Attn: Sgt. Lyman, 110 Church St., Chicopee, MA 01020. Please call (413)594-1700 if you have any questions or need assistance.
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