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HEALTH INFORMATION Child s Name Club or Sport Family Physician: Phone: Does your child have Asthma? Yes No Does your child have Diabetes? Yes No Does your child have Epilepsy/Seizures? Yes No Does
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The club or organization where the child is a member.
Parents or legal guardians of the child.
Fill out the necessary information about the child and the club or organization.
To provide documentation of the child's involvement in a club or organization for official records.
The child's name, the name of the club or organization, dates of membership, and any relevant activities or achievements.
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