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Participation Sports Examination Medical History Please answer the following questions by circling yes or no. If you answer yes, please explain at the bottom of the form and on back if necessary.

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4. If there are any sections that are not applicable to you, indicate this clearly or leave them blank, depending on the instructions provided.
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Please answer form following is a form used to request specific information or responses from another party.

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Please answer form following must contain the requested information or responses as specified by the party filing the form.

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