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Name: _______________________ Code: _____ _____ _____ _____ Sports and other extracurricular activities you will be involved in this year:
Any close family members who are involved in psychology or related fields: Relationship: ___________________ Field: Psychology ___ Psychiatry ___ Social Work ___ Other: ______________ I have read Diane Guido's disclosure document, and I understand the expectations for the course, as well as my responsibilities.
Signed ________________________________________________________ Date _____________________________
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