Superhero's name JJJJJJJJJJJJJJJJJJJJJJJJJ Parent's Signature

JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJ ❑ JJJJJJJJJJJJJJJJJJJ Institution

JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJ JJJJJJJJJJJJJJJJJJJJJJJJJ

jjjjjjjjjjjjjjjjjjjjjjjjj JJJJJJJJJJJJJJJJJJJJJJJJJ Address JJJJJJJJJJJJJJJJJJJJJJJJJ City, State, Zip JJJJJJJJJJJJJJJJJJJJJJJJJ Fax Number JJJJJJJJJJJJJJ Phone Number

jjjjjjjjjjjjjjjjjjjjjjjjj INDIRECT SUPERVISION LOG Cont Date JJJJJJJJJJJJJJJJJJJJJJJJJ Weekly Total Hours JJJJJ Supervisor Signature JJJJJJJJJJJJJJJJJJJ Date JJJJJJJJJJJJJJJJJJJJJJJJJ